The Problem With Personalized Medicine

gManZboy writes "Talk of individually tailored medical treatment isn't pie in the sky. This approach eventually will help us address risk factors even before a disease can invade our cells, and detect preclinical disease before it gets out of hand. What role will medical informatics play in this brave new world? Hint: Little data projects may be as important as big data projects such as gene sequencing. At a recent symposium on personalized medicine, Ezekiel J. Emanuel, MD, chairman of the Department of Medical Ethics and Health at the University of Pennsylvania, questioned whether it would make more sense to target all the lifestyle mistakes that patients make rather than analyze genetic defects. His view: 'Personalized medicine misses the most important fact about modern society--little ill health and premature death is genetic, much more is lifestyle and social.' Is Emanuel a dinosaur or a pragmatist?"

Comments

There would be no healthcare crisis in the U.S.

[Anonymous Coward]

if obesity could be rolled back to the levels it had in the 1970s.

 

Re:There would be no healthcare crisis in the U.S.

[Attila Dimedici]

That would be true if there was a healthcare crisis in the U.S.

Re:There would be no healthcare crisis in the U.S.

[tomhudson]

So ban HFCS (High Fructose Corn Syrup). It's a vicious cycle - HFCS suppresses the hormone that tells you you're full, so you keep on eating more food with HFCS, further suppressing the "Hey Dummy, Stoppppp!" signal.

Pigs eat corn to fatten up. It has the same long-term effects on humans.

Re:There would be no healthcare crisis in the U.S.

[somersault]

Indeed. Back in the 50s they started telling the world that all fat was unhealthy. People started eating low fat foods, and instead going nuts with sugary drinks/foods, refined carbs and fries. I hate when something says "low fat!" on the front, but it's like 50% sugar. Who cares about the fat content then?

Read up on Ancel Keys and the Seven Countries Study if you want to see where the idea that fat is bad came from.

Re:There would be no healthcare crisis in the U.S.

[FooAtWFU]

Give it another few years for Obamacare to come all the way online, and there may well be. ;)

(oblig. "I'll probably get modded down for this.")

Re:There would be no healthcare crisis in the U.S.

[Tsingi]

Give it another few years for Obamacare to come all the way online, and there may well be. ;)

(oblig. "I'll probably get modded down for this.")

Probably. The rest of the modern world all look after the basic medical needs of people, it's pretty much only the US that lets people die because they have no money.

Re:There would be no healthcare crisis in the U.S.

[rizznay]

Give it another few years for Obamacare to come all the way online, and there may well be. ;)

(oblig. "I'll probably get modded down for this.")

Probably. The rest of the modern world all look after the basic medical needs of people, it's pretty much only the US that lets people die because they have no money.

I came in to say the same thing Tsingi, there already is a healthcare crisis in the US, and anyone who tells themselves otherwise needs to do some research. The US has been behind in healthcare for years.

Re:There would be no healthcare crisis in the U.S.

[somersault]

True, though I don't think it's just that. Any high GI food supplies you energy faster than you can use it. So your body starts storing that excess blood sugar as fat as fast as it can. And then in a little while you're craving energy again, hungry and/or tired. Basically you get sugar withdrawals.

When I tried coming off carbs out of interest, I started in the evening. I felt incredibly tired the next morning. I went out for a walk (probably a mile or two in total) and was really worried I was going to fall asleep on my feet at one point.. but then by the end of the walk I felt good. Basically I think that was because if you exercise for 30 minutes or so you start burning fat for energy rather than relying on stuffing your face. Now I only eat "whole" carbs like brown rice and wholemeal bread/pasta/noodles/whatever. They don't give you the same sugar rushes and cravings that put your body on a chemical rollercoaster.

Re:There would be no healthcare crisis in the U.S.

[SuricouRaven]

Ban? I think just not subsidising it would be a start. The US government spends rather a lot of money paying farmers to grow corn in order to force prices down - and cheap-as-dirt corn is why HFCS is so cheap, and thus so popular in processed foods and snacks.

Re:There would be no healthcare crisis in the U.S.

[Tsingi]

+1 informative

Re:There would be no healthcare crisis in the U.S.

[fish_in_the_c]

and the average age could be rolled back as well. Much of the 'crisis' is due to a much older population needing more help to stay healthy.
An effect of the legalization of contraception.

Re:There would be no healthcare crisis in the U.S.

[Slime-dogg]

The high GI foods make you feel fuller, faster. The issue with HFCS is that it does not have a high glycemic index. Thus, you have a large influx of calories, which WILL be put to use by the body. If pop were made with cane sugar, there wouldn't be as bad of a problem.

Re:There would be no healthcare crisis in the U.S.

[slick7]

That would be true if there was a healthcare crisis in the U.S.

But there is a healthcare crisis, pharmaceutical companies, HMO's and political busybodies keep putting their noses where they don't belong. Healthcare for profit is not healthcare for the individual. The Hippocratic oath says,
"Do No Harm',
however, doctors follow the hypocritic oath that says,
"Do No Harm to the profits of corporate pushers and their questionable (at best) drugs".

Forcing mandatory healthcare down the throats of citizens by politicians who are bought and paid for by Big Pharma, is at best, unconstitutional.
These very same politicians, by the enactment of the National Defense Authorization Act, have declared war on the American population, thereby showing their utter contempt of these very same citizens which, at worst, is treasonous.

Re:There would be no healthcare crisis in the U.S.

[rickb928]

Pure B.S. Citations, please, beyond anectdotal stories of hospitals violating the law.

Bear in mind that in much of the world people die of disease or injury because they have no access to healthcare at all. Not just no money, but no transportation, no healthcare at all within reach. In the U.S., if you're sick and you can get to a hospital, you will be cared for. And you can probably hitch a ride to the hospital, with the police if no one else. Tell people in most of the underdeveloped world that they aren't denied health care because they have no money. And step back, lest they smack you.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

Being behind another country in something is not a crisis.

What exactly is the "Healthcare Crisis"?

Re:There would be no healthcare crisis in the U.S.

[somersault]

Well that's interesting about the GI of HFCS, but protein makes you feel much more full compared to carbs, certainly when comparing calorie-for-calorie. And since whole carbs, protein and fat takes longer to digest and absorb than refined carbs, they leave you feeling fuller for longer, without any rapid changes in blood sugar (which results in mood swings.. and more "comfort eating", rinse, repeat..).

Re:There would be no healthcare crisis in the U.S.

[aclarke]

The GGP said "modern world", which you're comparing to the "underdeveloped world". Therefore your response isn't really a fair one.

Maybe the point should be that only in the US do sick people undergo a lifetime of indentured servitude due to medical bills if they can't pay for insurance. In most other places, people don't have to bundle the choice to receive necessary medical care with the aftermath of crushing medical debt payments for the rest of their lives.

And yes, this issue does cause people to avoid the hospital until a little problem has become a big problem, in many cases fatal. Please refer back to Tsingi's "letting people die" comment. No medical system is perfect, but from my vantage point the American system is pretty messed up.

Re:There would be no healthcare crisis in the U.S.

[mjr167]

You don't have to drink pop. There are plenty of beverage choices that do not involve any form of sugar. We as people decided that we like pop so we drink it and companies cater to our whims. If YOU don't want to drink HFCS, then don't. Don't ask the government to force me to conform to what works for you. If there was one lifestyle and diet that worked for everyone, there would not be thousands of "lose weight fast and stay healthy on this brand sparkly new diet/pill/workout!" products.

My mother-in-law does not eat any carbohydrates and minimizes sugar intake to the point where she knows which vegetables have high sugar. That works for her. My mother tried the no-carb diet for a while and it made her violently ill. There are people capable of eating all day and not gaining an ounce of weight. There is no one-size-fits-all solution, rather general guidelines that appear to work for large sets of people. Each individual has to find a lifestyle that works for them. This is not a place the government needs to intervene by passing sweeping bans of harmless but commonly misused products.

Re:There would be no healthcare crisis in the U.S.

[realityimpaired]

Indeed. Back in the 50s they started telling the world that all fat was unhealthy. People started eating low fat foods, and instead going nuts with sugary drinks/foods, refined carbs and fries. I hate when something says "low fat!" on the front, but it's like 50% sugar. Who cares about the fat content then?

Yogurt is perhaps the biggest offender on that list. Real natural yogurt usually has a fat content somewhere between 4.5% and 6%. It may be higher, but it is difficult to actually make the yogurt with lower fat content, because it doesn't have the critical mass needed to thicken into something you can eat with a spoon. When you see a yogurt with 2% or lower fat, it's thickened by adding corn starch after the fermentation is completed.

And as others have pointed out, the corn starch and related sugars don't trigger the "I'm full" feeling, so not only are you consuming more calories, you're consuming calories that your body won't recognize as having been consumed... it's less filling and higher calorie density. :(

Just don't get me started on aspartame.

Re:There would be no healthcare crisis in the U.S.

[Dr_Barnowl]

The flipside is the high import tariff on cane sugar, which has it's roots in politics, and trade protectionism.

It's astounding how politicians go on about the invisible hand of the market solving everything*, and then putting it in handcuffs. Sugar import tariffs being one of those things. If the domestic price of sugar in the USA wasn't double the global price, HFCS wouldn't have ever gained the foothold that it has, and perhaps corn farming might have been replaced by some more productive use of the land (maybe switchgrass or one of the other feedstocks that the biofuel guys say actually provide a decent return).

* note that I am not one of these people, but I am pointing our their hypocrisy.

Re:There would be no healthcare crisis in the U.S.

[hedwards]

Not likely. It would probably mean that we'd be spending those dollars on other health care services. The reason why health care is so expensive in the US comes down to a few things. One, for profit entities in the system, that profit does jack shit for patients that can't afford coverage because it's expensive. Two the fact that you could get sick and then have your insurance dropped over a technicality or not renewed. Third the lack of preventative care that has been endemic in the system over the decades.

Re:There would be no healthcare crisis in the U.S.

[Greyfox]

Anecdotally a common problem.

Funnily how people will rabidly fight to preserve every egg that got a sperm in it, right up until the fetus squirts out of a woman's vagina. At that point it's either completely on its own or they actively work to kill it. Right up until it comes down with a terminal illness and wants some "medical lead" to end its suffering. Then it's back to it being immoral and illegal again.

Re:There would be no healthcare crisis in the U.S.

[hedwards]

It's not unconstitutional otherwise Medicare would have been thrown out by now. If you don't want the healthcare you have options. I bet you could move to Somalia.

I have a seriously hard time imagining how people could view healthcare as a tool of oppression. Very, very few people opt out in any sort of genuine way now, and under the reform law all you have to do is cop a religious exemption or plead poverty and you're out of it. Doesn't sound very mandatory to me. And even if you don't do that, the fine itself for not having coverage is a lot less than what you would pay for insurance that you aren't going to use.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

I wish women would look like in the 1970s... Like Jungle Pam.

Re:There would be no healthcare crisis in the U.S.

[Tsingi]

Awesome point of view, thanks. It is glaringly hypocritical when you put it that way.

Re:There would be no healthcare crisis in the U.S.

[greap]

The US has been behind in healthcare for years.

The metrics that actually matter to the people making use of the system, how more/less likely you are to die of ailment x in country y, shows quite the opposite. If you are diagnosed with any form of Cancer in the US you are more likely to still be alive after 5 years than anywhere else in the world (in some places, such as the UK, the survival rate is half of what it is in the US) and the numbers for almost every other medical problem shows the same pattern with the US being first or top three.

Other metrics such as accessibility the US is a leader in too. Access to doctors is 2nd only to South Korea, wait times for a hip replacement is 1.4% of what it is in the UK and 22% of the OCED average and on and on and on.

The crisis in US healthcare is that people are delusional enough to believe that insurance should cover regular medical expenses, such as doctors visits and the odd prescription drug, and as such pay absurd amounts of money for coverage they don't need; 25 million of us understand this and make a conscious choice to not buy it. If you are under 60 and not chronically ill you can save thousands every year by making use of a HSA & extremely high deductable policy but apparently if you suggest insurance is the problem not the cure you just hate poor people.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

Okay, you're right. Healthcare in the U.S. is better than in the rest of the underdeveloped world.

Feel better now?

Re:There would be no healthcare crisis in the U.S.

[ColdWetDog]

Furthermore, the ER is not the be all and end all of medical care. Treating chronic medical conditions from the ER isn't very useful nor satisfying to either the ER or patient. US FEDERAL LAW STATES ONLY THAT HOSPITALS HAVE TO TREAT PATIENTS FOR EMERGENCY CONDITIONS. Once the "emergency" is over, they don't have to treat you although it is often illegal to just dump a patient out in the street (those tend to be state laws).

And to continue - just because the ER has to treat you doesn't mean the hospital won't bill you. And try to collect on the bill.

So the stupid meme of the US has a health care for all is valid only for a very narrow definition of health care.

And yes, Virginia, there is a crisis in the US healthcare system. Not only do we NOT cover a significant portion of the population, we DO pay more to do so without any measurable benefit whatsoever.

Re:There would be no healthcare crisis in the U.S.

[ColdWetDog]

The metrics that actually matter to the people making use of the system, how more/less likely you are to die of ailment x in country y, shows quite the opposite. If you are diagnosed with any form of Cancer in the US you are more likely to still be alive after 5 years than anywhere else in the world (in some places, such as the UK, the survival rate is half of what it is in the US) and the numbers for almost every other medical problem shows the same pattern with the US being first or top three.

Total bullshit. US cancer death rates are in the middle of the pack on aggregate statistics. Yes, the US does pretty good for some cancers (for some people, most notably those with insurance), but not for all.

Nice of you not to buy insurance when you don't need it. Or don't think you need it. Most people I know don't plan on getting ill. It's not something that is on the calendar for "next year". But keep rolling the dice if you like.

Re:There would be no healthcare crisis in the U.S.

[AngryDeuce]

In the U.S., if you're sick and you can get to a hospital, you will be cared for.

And that care will be based directly on the patients ability to pay. For instance, it may be in the best interests of the patient to reattach a dismembered finger or toe, but if the patient can't afford the surgery, or if their insurance won't cover it, the finger or toe ain't getting reattached, even though it's in their best interests.

It's easy to say people will get help when it's a life or death emergency because to turn people away for that would be ridiculous and inhumane. But when it's a quality of life issue, it seems that dollars and cents rule the day just as much as they do in any other area.

I saw this myself with my step-sister when she got bladder stones while outside of her coverage area, she had two options, an endoscopic surgery that would have had her home the next day, or a traditional one that would have left her bedridden for weeks (an impossibility; she had a 2 year old at home). The hospital would not perform the endoscopic surgery, period, and advised her to just go home and get it done there. They were kind enough to give her a scrip for pain-killers, though, so there's that, I guess...

Re:There would be no healthcare crisis in the U.S.

[somersault]

Yeah aspartame is crazy.

For those who love diet drinks:

Nutrasweet (aspartame) is an artificial sweetener added to over 9,000 products worldwide. [...] Originally classified by the US Food and Drug Administration (FDA) as a neurotoxin (nerve agent), this chemical was developed as a chemical warfare weapon.

Re:There would be no healthcare crisis in the U.S.

[N1AK]

Don't ask the government to force me to conform to what works for you.

It's government intervention that has put HFCS into so many different products. Corn growing in the US can be done below cost because of government support, this keeps the cost down and that means that it gets stuffed into almost anything. Just about anywhere outside the US the idea of using corn syrup instead of sugar (cane or beat) would be crazy. If the government intervened less in farming then you'd see HFCS (and corn farming in general) decrease considerably in less than 5 years.

Re:There would be no healthcare crisis in the U.S.

[dpilot]

Just to throw a little fat into the fire, many of those politicians you mentioned crank about renewable energy subsidies as being "market-distorting", and had them high on the chopping block during budget negotiations. At the same time, we also subsidize the hugely profitable petrochemical industries to the tune of more than an order of magnitude greater. Yet that subsidy is "essential" and apparently not at all market distorting.

Specifically, the numbers I've heard were $13e9 for alternative/renewable energy subsidies and $400e9 for petrochemical subsidies.

Since this thread is also focused on corn, it also says nothing about the ill effects that our "corn manipulations" have had on Mexico. Though I'm sure it's an unintended consequence, first the price of corn dropped so low as to drive Mexican farmers out of business, then it bounced back higher than it was before, after the domestic supply was disrupted. Combine that with the side-effects of the War on Drugs, and the US has really screwed over Mexico. Then those same politicians mentioned above get all self-righteous about illegal immigration.

Re:There would be no healthcare crisis in the U.S.

[greap]

Total bullshit

Here is NiH on the issue with real data rather then crap from a WHO study based on a few bits of census data like the two links you gave, it shows US as leading the pack.

Perhaps in future check the sources on the crap you link to.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

Give it another few years for Obamacare to come all the way online, and there may well be. ;)

(oblig. "I'll probably get modded down for this.")

Probably. The rest of the modern world all look after the basic medical needs of people, it's pretty much only the US that lets people die because they have no money.

Money has nothing to do with it. It's illegal to deny people health care because they lack insurance in the US, and that's why everyone else's bills are so high. Hospitals have to recoup those costs somehow, and that was the entire aim of the forced insurance Obamacare policies.

What an ignorant statement.

Re:There would be no healthcare crisis in the U.S.

[sFurbo]

The GI of fructose is 19, the GI of glucose is 100. HFCS is about half of each. If I understand GI correctly, HFCS will probably have a GI around the average of the two, around 60. This is right around the 65 of sucrose. While that is lower than the GI for glucose, it seems to be pretty much where sugars end up. Am I missing something?

Re:There would be no healthcare crisis in the U.S.

[rickb928]

I'm missing your point. She had options? Why was going home unacceptable?

Re:There would be no healthcare crisis in the U.S.

[elucido]

So ban HFCS (High Fructose Corn Syrup). It's a vicious cycle - HFCS suppresses the hormone that tells you you're full, so you keep on eating more food with HFCS, further suppressing the "Hey Dummy, Stoppppp!" signal.

Pigs eat corn to fatten up. It has the same long-term effects on humans.

A ban on all ingredients associated with and linked to obesity should be law. HFCS isn't the only ingredient that destroys the metabolism. Obesity also isn't the only problem but a ban of HFCS is necessary because it's an unnecessary ingredient unlike salt which we can't live without.

Re:There would be no healthcare crisis in the U.S.

[AlecC]

While you are correct within limited bounds - the ER will treat people who turn up in an emergency situation, this actually covers a small minority. If you have cancer, you are not an emergency until the cancer is untreatable. If you have Alzheimers, you are not an emergency until you are totally mindless. If you are a diabetic, you are not an emergency until you collapse. What ERs do not provide is palliative and pain relief medicine which can stop people arriving in the ER. So what happens in the US is people are not treated until their condition has worsened so far that they really are an emergency. They are then rushed to the ER, where they are treated extremely expensively, until they are capable of standing upright, and discharged. This is like driving down the road by bouncing off the kerbs: taking no action until the emergency is upon you.

Because people are left untreated until they are in a really bad way, the US actually spends more per capita on "socialized medicine" through Medicare, Medicaid and funding ER than the UK spends on 100% coverage. The mechanisms described above, plus the huge cost of billing, mean that like for like treatments cost about twice as much in the US as they do in Europe. You are spending money to kill your fellow citizens.

Re:There would be no healthcare crisis in the U.S.

[celle]

"In the U.S., if you're sick and you can get to a hospital, you will be cared for. And you can probably hitch a ride to the hospital, with the police if no one else. "

    And sign away their lives while there're at it. You obviously don't know but medical care is prohibitively expensive for people who are living paycheck to paycheck nevermind the ones already in the hole. Thanks to our current plutocracy and the viewpoint of money is life(capitalism) here in the US, no one is going to wreck their financial future to save their life as with no financial future you might as well be dead. So requiring hospitals to help you isn't going mean much if no one is going to come in to become a financial slave for the rest of their life. (redundant but clearer)

    At least other first world countries took away the financial disincentive to get care.

    If wages had kept up with output and if people who did the work actually got paid the true value of that work as opposed to the middle men and upper classes getting it, the capitalistic system might have a chance to work somewhat better but right now at the national level its largely been a failure.(but a great scam)

PS. You want citations, you're on the net, look for them yourself as there's plenty around assuming you're willing to see them.

Re:There would be no healthcare crisis in the U.S.

[AngryDeuce]

Because her plane ticket was a week later, so her options were to be in crippling pain for a week, pay a bunch of money to move her ticket up and be in pain for a day or two while changing planes multiple times (with a 2 year old in tow), or have the traditional surgery and be bedridden for weeks (while still needing to reschedule her plane ticket, costing her more money, and still needing to figure out what she was gonna do with the two year old while she was convalescent). The option that was in her best interests was off the table due directly to ability to pay issues.

Point is, it was in her best interests to get the endoscopic surgery (the doctor himself even admitted this) but they were not going to do it because she couldn't demonstrate a sufficient ability to pay for it to the satisfaction of the hospital. Instead of doing what was best for her, they gave her a scrip for heavy narcotics (that she couldn't even take, again, 2 year old child to take care of) and told her good luck.

Re:There would be no healthcare crisis in the U.S.

[Belial6]

I hate when people try to rationalize a chemical being bad because it was "Originally classified" as something bad, or "was develeped as" something bad. Neither of those are legitimate arguments. Those arguments are exactly why the DHMO jokes are funny. http://www.dhmo.org/

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

Well, that's just because you are stupid. You aren't even talking about health care, you're talking about health insurance. Understand the difference, and you will be less stupid.

Re:There would be no healthcare crisis in the U.S.

[mjr167]

I'm fine with the government taking no action. If government intervention is artificially propping up a flawed industry, they should stop. It's the people clamoring to make X illegal because it's bad for me that I object to.

Re:There would be no healthcare crisis in the U.S.

[FalcDot]

Did you read that article you linked to?

"Cancer survival in black men and women was systematically and substantially lower than in white men and women in all 16 states and six metropolitan areas included."

Tell me that doesn't show that the more money you have in the US, the better your chances of survival.

Re:There would be no healthcare crisis in the U.S.

[geekoid]

Wrong.
A) We are talking about countries with money and power. IN the group, the us is last.

B) ", if you're sick and you can get to a hospital, you will be cared for"
Wrong. If you are experiencing lige threatening emergency, you can get care for.

C) "And you can probably hitch a ride to the hospital, with the police if no one else."
That's pretty niave.

D) ". Tell people in most of the underdeveloped world that they aren't denied health care because they have no money. And step back, lest they smack you."
this has nothing to do with the discussion. The US is NOT an underdeveloped nation.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

Actually it's not: it's seriously overpriced. In most of the underdeveloped world you can also get excellent healthcare if you can afford it. And it's a tiny fraction of the cost of US healthcare. For example an overnight stay in hospital in Bolivia will set you back $25.

Re:There would be no healthcare crisis in the U.S.

[DarkOx]

The trouble is most people are not covered not because they can't afford it but because they naively believe it can't happen to them, they are ignorant, or reckless.

Before the affordable care act it was estimated that 25% of the people without coverage already qualified for a federal or state program, that would cover them. They simply were not participating out of ignorance and laziness.

The rest of the folks most likely could get high deductible policies that would in fact cover them if disaster struck for less then $100 a month. Folks who did not fall into the first group most likely could afford this; even if it might be hardship. They simply choose to chance it instead, while some might be putting that money into a rainy day fund my guess is most are spending it on things that are not strictly needs.

Then there is the "pre-existing condition" group, who are only their by virtue of their own failure to put themselves into groups one or two.

The actual number of people who lack coverage through no fault of their own is vanishingly small. Which is not say there are not lots and lots of people who go without coverage; but you make your choices and you take your lumps. That is how its supposed to work.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

>> C) "And you can probably hitch a ride to the hospital, with the police if no one else."
> That's pretty niave.

Have you tried it? Turns out, the police are happy to get such a simple and straightforward call in all the areas I've lived. They aren't idiots, they understand poverty and health care to the extent most people do.

Re:There would be no healthcare crisis in the U.S.

[iter8]

Part of the reason that the US does as well as it does is because cancer is largely a disease of the elderly. Health care for the elderly is socialized through Medicare. The US is particularly poor on infant mortality because of lack of public services for pregnant women and infants. Extend Medicare to pregnant women and I'll bet that would turn around fast. There's a big US debate about saving random fetuses but the infants and mothers among the uninsured don't seem to show up on the radar very well.

Re:There would be no healthcare crisis in the U.S.

[greap]

Tell me that doesn't show that the more money you have in the US, the better your chances of survival.

That isn't the question, the question is does the US healthcare system do better or worse in treating illness in general (so for an average person) and the answer is it does better.

Dealing with the gap in treatment options between rich & poor is a different issue entirely and one that shouldn't focus on changing a system that maintains such a high average. The focus should be on costs and what influences them; hospitals are already mostly non-profit (less then 8% of hospitals with general admittance are for-profit), drug costs can be brought down by removing the import restrictions and ending the over-regulation of the approval process, primary care prices can be brought down by not stopping doctors from offering health subscriptions etc etc.

Re:There would be no healthcare crisis in the U.S.

[geekoid]

2 points:
1) Survival based on hospital only counts people who could go to the hospital.

2) The US is mid to low on any real metric.

I suspect that if you count the people who could not get any treatment at all until it became 'life threatening' the US would far much lower.

When people discuss umber about health care in the US, they seem to forget that the vast majority do not account for people who can not go to the hospital or doctor because they have no money. With cancer, want's it gets to the point where you could be considered an emergency, it's too late to do anything, so you are sent home.

Of course, the emergency room treatments make things more expensive for everyone who does pay. It would be far cheaper if everyone could go to the Doctor and get basic care.

Lets say you have an impacted tooth. This can lead to death. So, it gets infected, swells up and you go the the emergency room. Then they treat the infection and you have to leave.

But your tooth is still impacted..so you sue up the medication they give you and your infection returns rince repeat.

In a civilized country, that person could get their tooth removed.

Nice of you to cherry pick, but an objective view show the US isn't nearly as good as you seem to think.

Finally, it's laughable that you demand good links, but them make wild ass claims and don't provide any links.
I don't think you understand what it's like to actually be poor. Where the decision is..hmm the cheapest health care or food.

Also you ignore kids. Kids get injured, kids have medical issues. If I took your advice, my son could not ahe gotten the treatment he needed for is intestinal problem until he was on the brink of death. And even then they would have fixed his issue, only the immediate life threatening part; which would have return. Fortunetly I have insurance, so he got the 20,000 surgery are recovery.

Re:There would be no healthcare crisis in the U.S.

[geekoid]

National healthcare gets a better deal on drugs. You know who gets the drugs the cheapest? the VA. do you know why? volume.

SO some drug companies make some money? so what?

Re:There would be no healthcare crisis in the U.S.

[TheCarp]

yup, but you are not alone.

Sucrose is a glocose and fructose molecules stuck together. It is rapidly decomposed in the body into.... Glucose and Fructose. So... your body turns sucrose into HFCS. In fact, HFCS was formulated to be similar to sugar that way...on purpose.

So... HFCS is exactly the same as sucrose for most purposes.

However, GI is not the whole story. I highly recomend Lustig's talk on fructose as a poison for a more in-depth discussion (find it on youtube).

Short version.... carbs mostly degrade into glucose over time. every cell of the body, every bacteria, they all process glucose.

Your liver also processes carbs, some of it turns into glucogon, some into vLDL. The difference between fructose and glucose is.... only about 8% of ingested glucose is processed by the liver, whereas 90% of fructose is. Which means much higher vLDL levels (thats the "bad cholesterol" clogging arteries and all that good stuff).

In addition to that, its metabolism also interferes with leptin. This is probably the really important part. Because, leptin is the signal to your brain to supress hunger. It says "done eating, we have enough food". So, this fits in perfectly with studies that showed that a person who drinks a soda (thats takes in hundreds of calories) before a meal actually eats more...which is the opposite of what one would expect from a functioning feedback mechanism.

So not only does sugar/HFCS increase bad cholesterol, and make fat beyond that which other carbs (which mostly turn into glucose) do AND induces a person to eat more.... compounding the issue.

Now... its estimated that the average daily intake of sugar has gone from about 15 g/day (usually with fiber, as most natural sugar sources have fiber too) to over 65 g/day without fiber.

Oh and alcohol? Its a carb too. In fact, there is little difference, to the liver, between alcohol and sugar. Calorie for calorie, they almost have the same effect on the liver.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

I suppose Sophie had options too (see Sophie's Choice). Are you always this obtuse, or only when your sacred cow gets challenged?

Re:There would be no healthcare crisis in the U.S.

[toadlife]

If pop were made with cane sugar, there wouldn't be as bad of a problem.

"Thowback" Pepsi! It's the only dark soda I'll buy any more.

I was wondering if it might be a placebo effect, so I bought both the cane kind and the corn syrup kind and did a side by side taste test. The difference in taste was glaring.

Re:There would be no healthcare crisis in the U.S.

[TheCarp]

Yes. Absolutely. Siege Hiel!

There is no problem that can't be solved by the heavy hand and jack booted heel of government. Fuck educating people....just ban it all. Thats totally going to work this time. Just like it did for alcohol and drugs.

Re:There would be no healthcare crisis in the U.S.

[gd2shoe]

If you are under 60 and not chronically ill you can save thousands every year by making use of a HSA & extremely high deductable policy

Nice of you not to buy insurance when you don't need it. Or don't think you need it. Most people I know don't plan on getting ill. It's not something that is on the calendar for "next year". But keep rolling the dice if you like.

Dude, really? Did you not read what he wrote? Or are you being obtuse on purpose? A health savings account and a cheep policy is hardly uninsured. Granted, it only works if you are emotionally capable of saving a bit of every paycheck (and use some discrimination when picking the policy).

Re:There would be no healthcare crisis in the U.S.

[Kohath]

A ban on all ingredients associated with and linked to obesity should be law.

You are proposing to outlaw almost all foods with calories in them. You can become obese eating almost any energy-dense food -- about 90% of all foods.

Re:There would be no healthcare crisis in the U.S.

[greap]

The US is particularly poor on infant mortality because of lack of public services for pregnant women and infants. Extend Medicare to pregnant women and I'll bet that would turn around fast

See CHIP and WIC.

Re:There would be no healthcare crisis in the U.S.

[rickb928]

My wife and I pay punitive insurance premiums. My mother deals with Medicare weekly. I'm not unaware of the problems.

We are engaging in a discussion not of how to pay for healhcare, but of what role the Federal government should play. Massachusetts did this at the state level. Should we empower our Federal government to do this?

My personal opinion is no, both because the Federal solution is certainly going to be more expensive and questionably sufficient, and it is an unconstitutional exercise. States are not so limited. But are state solutions workable?

Re:There would be no healthcare crisis in the U.S.

[sjames]

If the prices weren't so entirely out of whack, most of us could go with high deductible insurance and just pay out of pocket for the rest. It's noot that people believe insurance should cover routine costs, it's that we have such a crazy scheme of billing (for example, hospitals charge several times more to patients paying out of pocket than they do to insurance companies) that people have to get their insurance involved just to avoid getting completely ripped off.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

In most cases, I agree with you - reduced fat often equates to unneeded and unwanted additives.

In the cases of higher-end plain Greek yogurt, however, there are no added thickening agents...
Specific examples: Chobani 0% plain is clean, as is Okios plain 0% (Dannon or Stonyfield Organic versions), and Fage Total 0%. Siggi's (actually an icelandic yogurt) does have a 'vegetable rennet' so YMMV on that one.

Since July 2010, I've gone from 404 pounds to my current weight of 205 at 5'11" (went as low at 193, but got a bit squirrelly). I accomplished this through lifestyle change - diet and some exercise. In the process, I beat type 2 diabetes, came off two other meds, significantly decreased the therapy on and pretty much gained my life back. In my case, the weight gain was due to medical issues (an undiagnosed thyroid condition for 5+ years), but once the extra weight got on (I was 456 at my fattest), and we'd finally dealt with the root cause, I had given up on myself. Enough on that...

The research shows that to make the losses stick, and to regain your health proactively, you must have your head in the game, and you must have a reason 'why' that is based on outcomes, rather than emotion. Make no mistake, it is never easy, and I'll be constantly monitoring and measuring for the rest of my life, so I never slip back into that state. But then, all systems stay in better control when we monitor and measure what is important, and take actions to reverse negative trends.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

I'm going to call shenanigans on this anecdote.

If she has insurance (and thus a "coverage area" to be out of) her insurance company could have been contacted to provide an authorization for the procedure and an agreement to pay for the care. If she was in one of the "super great awesome healthcare countries" we hear about - pretty much anywhere but the US, amirite? - she should have been treated without a need for insurance to get involved.

Also NO HOSPITAL is going to refuse you the cheaper, easier, outpatient treatment of a cystoscope for bladder stones - it involves inserting a small tube into the urethra, and extracting the bladder stones through it. It's easier, faster, has less complications, frees up a bed, and IT IS CHEAPER for everybody involved. The vast majority (some 90+% of cases, bladder stones pass naturally or can be extracted with a cystoscope). Also, 95% of bladder stones occur in men. Also, they're usually the result of other chronic urological problems, which she probably should've been seeking treatment for long before the stones developed, given that she had insurance and could easily have gotten treatment for any UTIs or other issues she was having.

The only way a hospital would recommend a traditional surgery for bladder stones is if the bladder stones are huge, and can't be removed through endoscopic means. To be clear: if the hospital was that eager to cut her open, she should THANK THEM for refusing to provide her with the cheaper, safer, better alternative of cystoscopy until she returned home. Pain for a week is probably a better option than wearing a diaper for the rest of her life because some third world butcher opened her up because he really wanted to cut someone.

Re:There would be no healthcare crisis in the U.S.

[Fallingcow]

Money has nothing to do with it. It's illegal to deny people health care because they lack insurance in the US, and that's why everyone else's bills are so high.

False.

What an ignorant statement.

Yep.

Re:There would be no healthcare crisis in the U.S.

[compro01]

It's illegal to deny people health care because they lack insurance in the US

It is illegal to deny EMERGENCY healthcare to people. Once they're stabilized, the emergency is over and they're not required to do anything further.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

And who will pay for this "educating people", you trouthead?

Re:There would be no healthcare crisis in the U.S.

[AngryDeuce]

It was over ten years ago, and while I may have the procedure's names confused, I stand by my statement concerning the options given to her. I was in the room when the doctor was talking to her. This occurred in Wisconsin, she was visiting from Florida, at St. Mary's Hospital in Madison, WI. I do not know who her insurer was, either. All I know is that she had insurance in Florida.

This was a private, out-of-network hospital, but as she was already on the hook for a hefty bill just for stepping into the emergency room, the other option (just go to another hospital and get another hefty bill for stepping foot into their also out-of-network emergency room) so she dealt with the pain and took her plane home to get the procedure done.

As for her seeking previous treatment for the "chronic urological problems", well, again, when you're a single mother with a two-year-old 2,000 miles away from family, I'm prepared to cut her a little slack if maybe she didn't run off to the doctor the second it burned when she pee'd for the first time. She was on antibiotics for a UTI already, she got those at the free clinic here in town since no one else would even see her for non-emergency care, but that obviously wasn't enough. It wasn't until the pain became unbearable that she even went to the ER.

When's the last time you made a non-emergency doctors appointment? Because around these parts, you're looking at a wait of at least 6 weeks, and that's with insurance at your own in-network provider; my sister-in-law's already been waiting 6 weeks already for her appointment dealing with her Fibromyalgia, and her appointment is in the middle of fucking February). When my step-sister called around she was told "Sorry, here's the address for the Free Clinic, good luck!". A few days later she was crying every time she used the bathroom...

Call shenanigans if you like; I know what I saw.

Your "third-world butcher" comment doesn't even apply, so I'll just go ahead and ignore that...

Re:There would be no healthcare crisis in the U.S.

[OrigamiMarie]

And that yogurt doesn't just have corn starch. Also gelatin and pectin. You know they're doing something wrong when they need three thickeners (besides the microbes) to make the yogurt set up. After eating a brand that has full fat and uses fewer thickeners for a while, I can now tell that Yoplait is halfway to being Jello, and I don't like it at all.

Re:There would be no healthcare crisis in the U.S.

[ceoyoyo]

"so for an average person"

There's a story about Nike that illustrates the dangers of using means (which is what your data uses as "average") instead of medians. Something about tens of thousands of third world workers making peanuts, Michael Jordan making bazillions, and Nike saying "look, our average wage is pretty good!"

Just because some rich people do really well doesn't mean you're doing a good job. And you neglect to mention that the US pays a LOT more for the health care it provides than pretty much anybody else.

Re:There would be no healthcare crisis in the U.S.

[TheCarp]

The same people who would pay for enforcing a ban. The same ones who pay for the current prohibitionist policies that are failing and filling up prisons. Who pays for those prohibitions, you anonymous coward.

Re:There would be no healthcare crisis in the U.S.

[Kohath]

This is false.

Healthcare spending is the result of the existence of more, better treatment options. Instead of dying from a heart attack, you can survive it now. Surviving it is a lot more expensive. You (or someone) must pay a lot of medical bills. You also get to live another 10 years by taking expensive pills, get cancer, and then maybe survive that. The bills just keep on coming.

Surviving that heart attack also leads to higher obesity levels. The dead aren't counted in the obesity statistics.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

And she couldn't make a call from Wisconsin to Florida to get authorization from her insurer for the procedure? Let me be clear: there is NO, N-O, Zero, Nada situation where an *insurer* will say "we want the risky, invasive, expensive procedure that will leave the insured bedridden in the hospital for a week, rather than that fast, less-invasive, safer, and far cheaper outpatient endocsopic treatment." Insurers will, and often do, authorize out-of-network procedures with just a phone call or two.

So for your story to be remotely true, one of three things has to be the case:
1) Your sister had such bad bladder stones that she was not a candidate for anything but the invasive surgery. If that was the case, it wasn't a case of dollars-and-cents or insurers driving the recommendation for care, it was a case of your sister being recommended the appropriate treatment for her condition, and that appropriate treatment *happened* to be "inconvenient" for her because she was traveling;

2) The hospital your sister visited (and any place she called around to) was incompetent, and didn't consider her a candidate for endoscopic treatment, when in fact she was; if that's the case, then I stand by my "third world butcher" comment - any hospital that will recommend invasive risky surgery (which is MORE EXPENSIVE and MORE time consuming) for a condition which can be adequately treated by endoscopy is simply looking to cut on people, and she's lucky she didn't get the procedure done there - it was professional incompetence, not "dollars and cents" driving the set of options she was given.

3) Your sister was simply uncomfortable, and while that's unfortunate, she was in no way in any life-threatening danger, and so was not a candidate for "free" emergency treatment for her condition, and so pain killers & "go home and call your doctor there," was an absolutely reasonable response to her condition.

I made a non-emergency doctor's appointment 2 months ago. I got an appointment three weeks from the date I called to make an appointment. Because it was... not an emergency. I made an emergency appointment last year to get an apparent strep throat infection checked out, and saw my doctor within 4 hours of the time I called, and had a prescription for amoxycillin an hour later. Also last year, I went to the emergency room after stepping on a nail that punctured my shoe and went into the sole of my foot; I walked in, established that I was in no immediate critical danger, and waited 2 hours while they worked on a guy brought in with heart failure by an ambulance was treated before me.

I fail to see why "6 weeks to get a non-emergency appointment" is so unreasonable, honestly. It's not an emergency, what's your rush? Do you really expect a team of doctors to be waiting at every medical facility, poised in readiness to treat the next patient to walk through the doors, regardless of the criticality of their condition? Because if that's what you want, then you're not going to get that by going to socialized health care, either, and you're sure not going to get that cheaply, either. And cost is something that does matter, whether it's private insurance or a public health plan - somebody has to pay for the treatment.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

"Marcus Aurelius: And what is Rome, Maximus?
Maximus: I've seen much of the rest of the world. It is brutal and cruel and dark, Rome is the light. "

Too many movies you watched, my friend? :)

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

Forget it, it's something you need to know when you get sick.

Re:There would be no healthcare crisis in the U.S.

[rickb928]

I am unfamiliar with the quotation. You presume much my friend, and in error.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

try getting emergency care in singapore if you don't have health insurance or can't provide a large stack of cash or a visa card

Re:There would be no healthcare crisis in the U.S.

[slick7]

I have a seriously hard time imagining how people could view healthcare as a tool of oppression.

When you lose all your money to the likes of MADOF or CORZINE or to TARP payees, living from day to day can be very oppressive.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

Greetings from the rest of the modern world. Here people die because health care system has not enough money.

Re:There would be no healthcare crisis in the U.S.

[slick7]

National healthcare gets a better deal on drugs. You know who gets the drugs the cheapest? the VA. do you know why? volume.

Cheap, useless drugs only help Big Pharma.

SO some drug companies make some money? so what?

When Big Pharma and their bought dogs of consgress outlaw natural substances because they can't be patented, thereby forcing you down dead ends and blind alleys of the CANCER moneypit, That's, so what.
I've had three tumor operations, none of which I would wish on my worst enemy or even you. I've seen relatives and friends die from chemo and radiation therapy.
I believe the reason I'm still alive is due to the fact that I refused all chemo and radiation.
Rick Simpson has a story to tell that you should listen to.

Re:There would be no healthcare crisis in the U.S.

[ColdWetDog]

That isn't the question, the question is does the US healthcare system do better or worse in treating illness in general (so for an average person) and the answer is it does better.

First, that's a fairly meaningless metric since few people are 'average'. Second, it was for only four (out of several hundred) types of cancer.

So, if it makes you happy that the US is, on average, better than average (but not markedly so) for treating four common cancers, then I'm glad - happy people live longer.

Hope you're happy with the bill....

Re:There would be no healthcare crisis in the U.S.

[ColdWetDog]

Which is not say there are not lots and lots of people who go without coverage; but you make your choices and you take your lumps. That is how its supposed to work.

Ah, but it's not how it really does work. I would agree with you that many people look at the risk / benefit equation of medical insurance, decide against it and cross their fingers. Most people will actually do OK with that decision. The ones that don't get the good dice roll often cost a bunch of money - that they don't have. A couple of things happen. The get poorer treatment (OK, their decision) but the treatment the do get (say through the ER or after they get admitted to the hospital but don't pay) gets expensive.

At my small, rural hospital we are about one million dollars in the red this year. That's just about the money we spent on 'uncompensated care'. That gets payed out by 1) the town - which can ill afford it as we're looking to quit paving roads because we don't have the money and 2) hospital reserves which we can also ill afford because we need to replace the roof and a couple of other important things.

So, the 'bad' decision by a few people ends up costing the rest of the local society some real cash.

If you think that we should simply not elect to treat people without insurance, then you need to convince the Feds to drop a whole bunch of rules, regulations and laws. Good luck with that.

And your cost estimates for a high deductible insurance package are rather low. Double it and pray you don't have any pre existing conditions.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

I beg to differ. The US has the healthcare system of an underdeveloped nation, and given the number of fuckwits who think that's a good thing, it clearly has the education system of one as well.

Re:There would be no healthcare crisis in the U.S.

[Paul Fernhout]

"this has nothing to do with the discussion. The US is NOT an underdeveloped nation."

Not only that, but the USA has had a role to play in keeping (materially) underdeveloped nations underdeveloped.

Re:There would be no healthcare crisis in the U.S.

[Paul Fernhout]

"No medical system is perfect, but from my vantage point the American system is pretty messed up."

Even worse, the real solutions (prevention and cures) are not very profitable (compared to palliation and treatments). For example, expensive international heart surgery as $50K+ a pop is basically a "scam" according to Dr. Joel Fuhrman:
http://www.drfuhrman.com/library/PCI_angioplasty_article.aspx

On top of that, diverting money to what really is "sick insurance" prevents it from being invested in wellness, like building parks, creating walking trails and bicycle paths, subsidizing cheap vegetables, fruits, and beans (healthier to eat), and so on. Worse, we subsidize and propagandize about unhealthy foods, like (for many people) dairy, factory farmed meats, and products with refined starch and sugar:
http://www.seriouseats.com/2007/11/the-subsidized-food-pyramid.html
"The Physicians Committee for Responsible Medicine has posted an easy-to-understand visual on its site that shows which foods U.S. tax dollars go to support under the nation's farm bill. It's titled "Why Does a Salad Cost More Than a Big Mac?" and depicts two pyramids -- subsidized foods and the old recommended food pyramid. It's interesting to note that the two are almost inversely proportional to each other."

Here are some real solutions to obesity and other chronic issues I've collected:
http://www.changemakers.com/discussions/discussion-493#comment-38823

They are relatively basic things like getting enough vitamin D, eating lots of vegetables, fruits, and beans, and so on.

That said, 20% of modern medicine in miraculous. The problem is, doctors and the medical system don't seem to be able to so the right thing the other 80% of the time (especially for chronic disease) and do problematical interventions instead.

So, in general, I agree with Dr. Ezekiel J. Emanuel's point. Still, advanced technology can play two important roles.

One is advanced diagnostics. Imagine a test kit (or device) you could buy at the supermarket that would tell you if you had any nutritional deficiencies. Then you could look up what foods or recipes would help in fixing that.

The other is in living well beyond 80-120. Good nutrition may be able to get most people into 80 still doing fairly well, but getting past 120 is going to take advanced technology (which entails confronting a complex ethical, moral, and spiritual issue about the meaning of life, made even worse if life extension is available only to some).

But why put so much money into making "magic bullets" to shoot the apples from the top of the tree when the low hanging fruit is being ignored?

Re:There would be no healthcare crisis in the U.S.

[somersault]

I just pasted that quote because I find it funny that we're using chemical warfare agents as food additives. I'm quite aware that anything can be dangerous if ingested in large enough amounts, but this stuff is no good for you at any dosage.

You're free to ingest whatever you wish, but studies on aspartame and sucralose have not shown any health benefits, while creating an impressive list of health problems. If you want more detail, try Googling.

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

when you're a single mother with a two-year-old 2,000 miles away from family, I'm prepared to cut her a little slack if maybe she didn't run off to the doctor the second it burned when she pee'd for the first time. She was on antibiotics for a UTI already, she got those at the free clinic here in town since no one else would even see her for non-emergency care, but that obviously wasn't enough.

Two thoughts:

1) Since when is a urinary tract infection not an acute-care scenario? You make it sound like she called the doctors and told them, "I have a urinary tract infection," and they told her "Well too fucking bad, I can't see you for a month." No COMPETENT doctor would do that, because it's an acute ("emergency") care situation where treatment is needed immediately - the doctor might say "go to the emergency room, I can't see you today," but it's a malpractice suit waiting to happen for a doctor to say "just tough it out, sweetie, I'm sure it'll go away." All she had to do was call the doctor to start the ball rolling - she could have seen someone that day if she wanted to, you and I both know that.

2) If she had medical insurance as you claim, and delayed seeking medical care while it was a mild condition that would be easily treated, and then ended up with a more severe & painful condition as a result of her delays, that's HER fault. Not the health care system's fault, not the doctor's fault, not Obama's fault, not George Bush's fault, not France's fault, and not America's fault. HER FAULT. She delayed seeking care, and so exacerbated her own condition.

Also, re: the call of shenanigans... you know an AWFUL lot about your sister's bladder health and treatment for a fairly minor condition 10 years ago, which strains credulity friend. Just sayin'.

Re:There would be no healthcare crisis in the U.S.

[Belial6]

And yet you ingest an industrial solvent every day, and the whole while think it is healthy? A chemical that has specifically been used to kill people when they have been sentenced to death. The quote you used is ridiculous. It is only funny in the "look how stupid the quote is. And see how dumb the people that take it seriously are." kind of way.

Re:There would be no healthcare crisis in the U.S.

[somersault]

It's amazing how in every single post you make you manage to be more of an asshole. I already knew all that, and I still find it funny. You just have absolutely no sense of humour.

Re:There would be no healthcare crisis in the U.S.

[somersault]

BTW, if aspartame were safe, then it obviously would be dumb to have said that. But it's not safe, and you fucking know it. You are being rather retarded by suggesting that just because anything can be framed in a poor light, that such framings should never be taken seriously. My intention was to get people to read into artificial sweeteners themselves, rather than post a whole bunch of references.

Re:There would be no healthcare crisis in the U.S.

[Belial6]

You don't seem to know what an asshole is. An asshole is someone who says something that is incredibly stupid, and the gets aggressive when they are called out on it. You said something incredibly stupid. You take the stance that no one should contradict you because "it was a joke". Clearly you don't think it is a joke. You are completely serious. You say so in the post following this one. So, not only are you stupid. You are also a liar.

Re:There would be no healthcare crisis in the U.S.

[AngryDeuce]

I know a lot about it because I was the one that had to get up at 2 AM to drive her to the fucking E.R. with her son in tow. I worked a night shift the night before and a morning shift the next day so I had all of two hours sleep in a 36 hour period.

The night made a bit of an impression. Between her screaming and crying, and her son crying, and no fucking sleep, I thought I was going to go fucking crazy.

Believe what you want...

Re:There would be no healthcare crisis in the U.S.

[drsmithy]

Your statistics are all predicated on the ability to access care. Thus, they are ignoring the actual problem to present a specious argument.

Re:There would be no healthcare crisis in the U.S.

[somersault]

You are acting like the two are mutually exclusive. I think it's serious, but also funny that people are that stupid that they think that eating nerve agents is a good idea. Do you even know what a nerve agent is? It may not be strong enough to kill a human in those doses, but it's strong enough to kill your intestinal bacteria, and that is a bad thing.

The way you talk always just comes across as being an asshole. Even as I was writing the original comment I was imagining the typical slashdotter attitude of someone saying that vitamin C or even water in high enough doses are bad for you, but I was trying to keep my post concise, and amusing. It is an amusing fact. Even if it was good for you, it would still be an amusing fact. I stand by my point that you are just being an asshole. I think a better definition of an asshole is someone who tries to be awkward just for the sake of it, and make other people miserable by telling them things that they already know, but don't really care about.

You don't seem to realise that the dihydrogen monoxide stuff is a parody. It does make a valid point, but it doesn't mean that every time someone says something bad about a chemical that you should ignore it.

Re:There would be no healthcare crisis in the U.S.

[somersault]

Something else is pissing me off here - I never said "it is a joke", I've only ever said that it was funny/amusing. So really, you're the one lying. Please actually read what I've said before "quoting" me again.

Re:There would be no healthcare crisis in the U.S.

[Belial6]

You are trying to split hairs on the language. When you say something that is funny, you are telling a joke. Getting "pissed" off because someone calls you out on it doesn't stop you from being a lair. it doesn't make the other person a liar. It makes you an aggressive asshole liar that thinks being aggressive makes your stupidity not count.

I go back to the beginning and say that the only funny thing about your comment was how stupid someone would have to be to think there was any validity to it. You clearly believed it was a valid statement. You saw it as a "It's funny because it's true" style statement. It is only "true" in it is in the "too stupid to understand that there are only 118 known elements" way.

In case you didn't get it. The entire DHMO joke is to make fun of people EXACTLY like you.

Re:There would be no healthcare crisis in the U.S.

[Belial6]

You acknowledge that DHMO is a parody, yet you use the exact same flawed logic and think it is right. That doesn't make me an ass. It makes you aggressively stupid.

Re:There would be no healthcare crisis in the U.S.

[somersault]

I'm being aggressive because I remember you from before, and I remember that you're a jerk. Also because you're quite tiresome. I usually try to help people out even when they're assholes, but you try my patience. Anyway, let's continue:

I "got it" before you even posted. I already told you I actually imagined someone posting pretty much what you posted, but was hoping that nobody would be that petty. Do I really have to spell out the obvious every time I post, just so that people like you won't spend all your time complaining?

The DHMO thing was created to see how gullible people are - whether they accept things without thinking about them. The joke is not the way that the facts are presented, the joke is that most people just accept things without further study. This is Slashdot, and I fully expected people to go and actually do further study.

Though apparently you haven't, so let me do it for you; here's a list of symptoms people have reported to the FDA after eating foods containing aspartame. Gee, those symptoms look an awful lot like those caused by nerve agents! I WONDER WHY?

Re:There would be no healthcare crisis in the U.S.

[Belial6]

So, your a self declared troll, you call people assholes who call out the stupid BS you spew and you find it tiresome when people don't respond to your trolling the way you hope. You have decided that this makes me a jerk. Check.

Re:There would be no healthcare crisis in the U.S.

[somersault]

"you're".

Re:There would be no healthcare crisis in the U.S.

[sFurbo]

So the really short version is that HFCS has the same effect as the same amount of sucrose? And the villain is really refined (fructose-containing) sugars and higher caloric intake?

Re:There would be no healthcare crisis in the U.S.

[Anonymous Coward]

Oh and alcohol? Its a carb too. In fact, there is little difference, to the liver, between alcohol and sugar. Calorie for calorie, they almost have the same effect on the liver.

I believe you meant between alcohol and fructose. There is rather a lot of subletly in this discussion such that care is needed in using the correct terms.

Re:There would be no healthcare crisis in the U.S.

[KermodeBear]

And government-run health care is also based directly on the government's ability to pay.

What happens when the government money set aside for - as an example - hip replacements runs out? I'll tell you what happens, because it happens a lot where I live. People from Canada will cross the border and drive down into the United States where they can get the surgery done instead of having to wait 4-6 months for the funding to become available.

Living near Cleveland, I frequently see Canadian license plates going to the hospitals in this area. They're not doing this out of convenience.

Re:There would be no healthcare crisis in the U.S.

[elucido]

A ban on all ingredients associated with and linked to obesity should be law.

You are proposing to outlaw almost all foods with calories in them. You can become obese eating almost any energy-dense food -- about 90% of all foods.

HFCS isn't food, it's an ingredient.

Excuses sell better than solutions

[Anonymous Coward]

Everybody knows this, but medicine is a business first. Excuses sell better than solutions. End of story.

Sane

[stanlyb]

He is just a sane and honest man. It is no coincidence that in some areas live people more than 100 years without any medical treatment, and snacks, and chips, and coke, and GMO (as a matter of fact), and ......i arrested my case.

Re:Sane

[Anonymous Coward]

Ancient chinese secret: selective breeding is just GMO with less variables.

Re:Sane

[tepples]

And according to opponents of recombinant GMO, those more variables are what pose the threat to a nation's food supply.

Re:Sane

[Anonymous Coward]

You do realize we've had GMO or the equivelent for thousands of years right?

Man bred one type of cattle to another, creating cross-breeds and hybrids never before seen. Man pollinating one kind of plant to another either by walking past two kinds inadvertently or by collecting and depositing on purpose.

Today we just do it at the genetic level, but it's essentially the same thing. Crossing one beneficial trait with another. Yes they are taking shortcuts, introducing traits that came from a genetically diverse plant (ie different species), but really, it's not that much different.

The main difference is their attempts at making them sterile so that they are the only source for said variant. That's where problems exist. What was it that was said in Jurassic Park? "Nature will find a way."

Data-driven loop closure is the holy grail

[taliesinangelus]

Through initiatives like NEMSIS (www.nemsis.org) and marrying that data with ER/hospital data, the loop closes for providers in the continuum of care. The data can drive performance improvement for each step in that continuum of care as hospitals have never been so informed about what happened on an EMS call and vice versa. This directly improves patient care on an individual level and on progressively higher levels. Several states are doing this with data with the leader being North Carolina.

The preclinical diagnostic power suck

[G3ckoG33k]

The preclinical diagnostic power suck.

That is why this is not a good route.

Diagnostics even in the clinical stage is not often very well founded, unless you have a broken leg or something to that effect. Psychological disorders are really, really difficult to diagnose with decent accuracy, and therefore should never be treated a preclinical stage.

A can of worms or a jar of pills?

Re:The preclinical diagnostic power suck

[Belial6]

Psychological disorder diagnosis gets even worse when you consider that as frequently as not, being PC is used as a diagnosis method.

Pragmatic, Somewhat. Maybe:

[Hartree]

Part of the question is CAN it really be effectively changed by lifestyle changes over a whole population?

It's easy to say "eat less fat, and fewer calories and it will be better". We hear that all the time. Exercise more. No alcohol to excess.

But, actually getting people to follow it in a sustainable way hasn't happened in many cases.

When you have a method that well work, but you can't get people to follow, it's not very effective.

In some cases, drug interventions are more likely to be followed. Take a look at cholesterol meds (I live on em.). You can get people to take a pill a day more easily than giving up the cheeseburgers.

Maybe it should be that they change their lifestyles, but that's not the way it happens much of the time.

Another area which personalized med will help greatly is choosing which medication to use. Many times treating chronic illnesses requires switching drugs several times to find the ones that work best with fewest side effects. Having testing to identify how your body will react to a given medication would be very helpful.

Re:Pragmatic, Somewhat. Maybe:

[stanlyb]

Have you seen any FAT lion??? I wonder why not!!!

Re:Pragmatic, Somewhat. Maybe:

[Hartree]

Because though there is an illusion of freedom in the wild, lions are strictyly hemmed in by mother nature in terms of calories.

They have to compete with other predators whose territories surround theirs and the reality that they can only harvest so much food and not deplete their territory. That's why there hasn't evolved such a strong ability to limit intake. It's mandated by the physical environment in animal societies.

Do you really want a society where caloric intake is strictly regulated by physics (or humorless people assigned to snooping on everything you eat/do)?

Re:Pragmatic, Somewhat. Maybe:

[Anonymous Coward]

I think that you answered the question in your response: of course he's being pragmatic.

Doctors can look at your lifestyle choices and let you (and other doctors) know why you are dying faster than you think you should. Perhaps they will have treatments to help slow your own self-destruction, maybe they won't, but at least it won't be a secret to anyone why your health is in rapid decline. And this is especially nice for medicine as a science because adopting this method of diagnosis coupled with open information sharing (if that existed) could allow large scale data modeling to better show correlation and causation as people continue to chose cheeseburgers over the possibility of more time with their loved ones. Doctors aren't your parents or god or something, they can't make you stop killing yourself, they can just tell you that you are and try to develop ways to slow it down or make it more comfortable.

Not only is it a wonderfully pragmatic view, but it's a win win situation for medical science.

Re:Pragmatic, Somewhat. Maybe:

[RicktheBrick]

Last year I was told that I should have my gallbladder taken out. Instead I changed by diet. I became a full vegetarian and use olive oil instead of vegetable oil and olives instead of fish. I eat a lot more raw fruits and vegetables now and I still have my gallbladder.

Re:Pragmatic, Somewhat. Maybe:

[Hartree]

Indeed. It worked. What worked was one of the most effective ways of changing behavior there is. Fear.

But, as I mentioned in another post, just relying on fear is limited. We've been getting out the word on obesity for decades. But, it's not producing fear in sufficient amounts to broadly change behavior. Our minds adapt to the situation, and we have an amazing ability to rationalize. Those traits served well in an animal environment where calories were limited by the environment. If there was excess food, the population rose to meet it. Or another species increased.

Now we have a situation where society/indvidual controls aren't working as well as they have in the past due to it being a different situation (whether it's HCFS or food immediately available on impulse, etc, etc take your pick of whatever cause you favor. I suspect it's not just one.).

The methods we have been using aren't working so well. Or at least, the social costs of imposing those methods in a way strong enough to work are awfully high.

Re:Pragmatic, Somewhat. Maybe:

[Belial6]

You are wrong about that though. While we have been getting the word out on obesity for decades, we have also seen HUGE changes in behavior from it. The problem is that much of the advice is counter productive, and a major reason for people getting heavier.

First, the normally accepted definition of "obese" is stupid to begin with. This is what is considered obese by our government/medical/insurance industries: http://www.schwarzenegger.it/mro/schwarzenegger.html

That's right. 100% of the time that Arnold Schwarzenegger was Mr. Universe, he was considered "obese".

Then you have to look at how people are told to avoid "obesity". Exercise more, eat less, avoid fat, stick to sugar. That is the advice they are given. This advice is actively harmful. Not everyone has the same genetics. I, for example, have a lean body mass that places me only 10 pounds below the "overweight" mark. That is with very little exercise. I also pack on muscle extremely easily form exercise, so if I were to actually go to the gym 3 times a week, my lean body mass would be pushing me over the "overweight" mark. My body fat on the other hand is regulated almost exclusively by diet. A lack of fat, and almost any sugar makes my body store fat.

So, the currently "accepted" healthy lifestyle that is supposed to keep me from being fat has me starving (in the literal sense, not the "I'm really hunger" sense) in an attempt to force my body burn fat that my body is storing due to a diet that is exactly the opposite of what it needs. Then if I successfully starve off my fat, I am starving (again literally) my body in an attempt to remove the muscle that the exercise is putting on. I would be waging a battle in my body between putting muscle on through exercise, and eating it away through starvation to get below the "overweight" threshold.

No sane person could see that as healthy. All the while, our society/government/medical/insurance industries would be patting the guy next to me on the back while he sits with this 30% body fat because he happens to be a couple of inches taller, and his body doesn't produce muscle.

Using fear as a motivator doesn't solve a problem if you are using fear to chase people directly into the problem you are trying to avoid.

Re:Pragmatic, Somewhat. Maybe:

[Hartree]

"we have also seen HUGE changes in behavior"

Yes. We've seen a creeping move toward less physical activity in the population and eating more of a fast food diet. (couldn't resist that one. ;)

As to the problem of standards:

There were a lot of people who pointed out the disparities in the body mass index and neck waist ratios in the military. And there, you have a higher proportion of highly athletic people than the general populace.

So, yes, there was the weightlifting farmer in my Guard unit that was over the body mass indices. There was also my platoon sergeant who was definitely overweight, but had an 18 inch neck size, so he still technically passed.

But in general, though BMIs and the like are flawed, they aren't the source of the problem.

They're the source of different problems like you mention.

The obesity problem is real, not just created by the lens of statistics we're looking at it with.

And yes, though fear is effective, I certainly don't argue for it. It tends to result in misapplication and side effects like you mention, or witch burning, or the like.

Make people afraid of obesity to a greater extent and you will soon find they are also afraid of the obese to a greater extent.

Well...

[fuzzyfuzzyfungus]

Arguably, targeting things like lifestyle factors is also "personalized medicine", in the sense that treating patient X specially because a defect in their homozygous foo allele predisposes them to cardiac disease isn't all that different from treating patient X specially because getting no exercise predisposes them to cardiac disease.(and, in uncomfortably-many-but-not-all cases, the "personal" element is just the most visible factor in a stew that includes environmental and social influences, like diesel soot and cube farms...)

I'd be inclined to say that Emanuel is neither a dinosaur(he isn't rejecting the new-and-shiny out of hand, just pointing out that much of it offers questionable bang-for-buck compared to the low hanging fruit offered by seriously boring lifestyle stuff), nor a pragmatist(y'know why people like to ignore lifestyle factors and focus on genetic whiz-bangs and hypothetical personalized super-pills? Because lifestyle intervention lies dead at the center of the intersection of "really boring", "really hard", and "lousy patient compliance".

We already have plenty of good advice to go around(by no means perfect knowledge; but we know much better than we do), largely unheeded and often coexisting with social conditions that actively work against heeding it. We don't actually have personalized genetic-super-pills(with limited but important exceptions: oncology, for instance, has a number of genetic markers that have proved tractable to test for and highly useful to know. Some rare hereditary disorders have also been well worked up. Much of the rest of it remains in the "yeah, it sure does appear to run in families; and we made this mouse model by tweaking the genes like so; but that doesn't help you very much...); but we could probably get people to take them fairly regularly if we did...

Re:Well...

[Anonymous Coward]

I agree up until the point where you say we already have plenty of knowledge. The vast majority of medical knowledge we have is vastly undersupported in terms of clinical trials/observational studies. For example, we preached hard about weight for decades, and now the latest research possibly suggests that weight is secondary to fitness level. We went on and on about avoiding dietary cholestorol, only to discover that organ function and genetic factors are far more important in controlling cholestorol, and that having too little cholestorol can be harmful too (and I am only talking about "bad" aka LDL cholesterol).

These are just a few of literally thousands of recommendations without a solid grounding in reality. EHRs, integrated healthcare information systems, and yes, genetic data, have the potential to enable us to finally gather the information necessary to answer these questions. Right now there simply isn't the quality data and infrastructure needed.

I am not suggesting that we don't know anything. We do know quite a bit about leading a healthy life....but we need a lot more knowledge and we still need to find ways to use technology to make adherence easier for patients. Of course none of this can ever force people to take care of themselves....but you change what you can...

Re:Well...

[ceoyoyo]

It's a silly distinction. Has your doctor ever asked you about your family history? Genetic based personalized medicine. Has your doctor ever asked you if you smoked, how much you exercise, what you eat? Lifestyle based personalized medicine.

"Personalized medicine" is just coming up with better tests to do these things. Genetics had a heyday where it was the cause of (and solution to) everything. That's ending as we learn more.

The use

[fish_in_the_c]

One of the things 'personalized' medicine addresses is the 'well that's not me' factor that is in may people mind.
The reality is that a percentage of people in the population will never need to worry about cholesterol problems and the knowledge that such people exist allow others to live in the illusion that they may not have to worry about it either.
Personalized medicine will allow the Dr, to tell a person YOU need to not 'X' or you will have 'Y' happen.

The problem however is that it is always a percentage game. Some of the genes we have found so far increase a persons chances of developing a certain type of cancer by 1 or 2 %. So is that enough to warrant changers in behavior.

People who work in computers for a living already know that their carrier choice raises their cancer risk by something like 20% ( how many of them left their careers because of it though).

Part of the problem is understanding the risk ... and them excepting the consequences if they show up.
( are we allowed to do that anymore !!)

Re:The use

[Anonymous Coward]

Bad spelling aside, this is a bigger problem in socialized medicine. If the government pays everyone's medical bills, then the government has an incentive to keep people healthy, and the best way to do that is through force. If you want someone to take responsibility, then you need to educate them - your family is predisposed to heart attacks so if you keep eating at McDonalds, you may need to pay for the following operations in the future at a cost of X. As long as a patient is aware of their own situation and understands the potential costs to them in terms of money, quality of life, or time, then you can't do much more.

Re:The use

[Anonymous Coward]

"People who work in computers for a living already know that their carrier choice raises their cancer risk by something like 20%"

Can you substantiate this claim?

Practical advice is not what people want

[Anonymous Coward]

Emanuel is right, but experience tells us that people don't want straight-forward advice about not eating deep-fried butter or exercising more. They want to do it anyways and be saved by medicine when it catches up to them.

Pragmatically speaking

[overshoot]

He's right, it would be vastly more effective (not to mention cost-effective) to address the lifestyle risks.

Now: for a quick assessment of his chances: how many of us are sitting around on our butts reading /. instead of getting some exercise?

Yeah, I thought so. Maybe the genetic screening is worth doing after all.

Re:Pragmatically speaking

[Hartree]

Bingo. I already commented or you'd get modded up.

There's a saying for that:

[Hartree]

"If a frog had shock absorbers, it wouldn't bump its butt when it hopped."

Easy to say. It's proved more difficult to actually get people to lose weight.

Re:There's a saying for that:

[Anonymous Coward]

Somewhat off topic, but you know what really motivates you to lose weight.. heart problems.

Seriously.. Used to be pushing 260lbs.. started having issues with my heart (which incidently turned out to have nothing to do with the weight or anything I could have really controlled) which scared the shit out of me and I lost that weight in a damn hurry (well, as hurried as was safe according to my doctor).

Re:There's a saying for that:

[Hartree]

Lets distill it down even more. Fear is often what motivates.

Not surprising. That's how we evolved. Fear kicks in and we move.

But, as I mentioned in another post, slowly changing things like weight and lifestyle don't raise fear in and of themselves.

Regardless of how much it makes sense, you have to find a way of getting people to actually go along with the lifestyle changes. And that's not always easy to do in a way they won't consciously or subconsciously rebel against.

Having everyone get diagnosed with life threatening very scary illness probably isn't the way to change behavior. It might well work, but it has downsides.

Having people in a controlled military like environment WRT eating and exercise, for example, might well work wonders for their physical health. But it's neither something most would opt for, or really a reasonable option.

I'm certainly implying "just give up". I'm just saying that our usual social control mechanisms which are little changed from say, the Roman Empire, haven't been as effective with this as they are for some other things. I'd love some new ideas.

Re:There's a saying for that:

[Hartree]

Should be "certainly not implying".

Gah, mornings.

Re:There's a saying for that:

[RulerOf]

Not surprising. That's how we evolved. Fear kicks in and we move.

But, as I mentioned in another post, slowly changing things like weight and lifestyle don't raise fear in and of themselves.

It's funny looking at it that way. I recently started exercising regularly; and by recently, I started "exercising" by taking daily walks with my girlfriend in October, about a mile or so, but they got longer as time went on. As it gradually grew Too Fucking Cold(TM) to walk outside at any time of day (yay, Ohio!), we began following exercise videos. I'm between 3-4 days a week, but I'm trying to bring myself to 6. My goal is to be in good enough shape to start P90X by March. It's a shitty realization that you're too out of shape for an at-home exercise regimen :D

Nonetheless, while I don't appear to look anywhere near athletic, it really is amazing how much more empowered you feel on a daily basis. Something has metaphorically pricked the back of my neck now that I'm 26. I know that I can still "look good" when I clean myself up, but that really only has do with qualities I know are directly attributable to my age---I won't have a youthful face and dark, thick, curly hair forever. If I don't lose weight, I'll just eventually be the fat guy in a nice suit... that probably needs a haircut.

Sure, it might be insanely trite to sit here and essentially say that my fear is that I'm finally realizing that I could very easily end up with absolutely nothing to give myself a small sense of vanity, but with that comes self-esteem, and with that comes confidence in what you do and how you present yourself. And that, I think, is about as poignant as it probably gets.

Re:There's a saying for that:

[Hartree]

Fear's not the only motivator by any means. It's just a pretty effective one. There are a lot of others.

You've got someone you enjoy being with doing it with you. That helps a lot.

My point is about the general population. Inidividuals find lots of reasons and motivations for doing things.

But, if we're going to broadly apply lifestyle changes, we have to find something that will motivate a broad range of people who have thus far proved resistant to existing efforts.
 

missed it by a mile

[Anonymous Coward]

You're coming at this from the typical leftist viewpoint of desiring to control everyone's lifestyles and choices, but that's not what personalized medicine is about. It's about figuring out what medicines you'll respond to the best, based on your genetics.

From your progressive, utopian angle you could also view it as avoiding administering expensive treatments that won't do much good for that patient, and thereby reducing total healthcare costs to the system. But the term is not about molding a more perfect society through more socially-correct behaving citizens. There are other words for that.

Human Nature

[gutnor]

It is easier to "sell" (as in commercial, or even simply convincing) some treatment against a silent potential killer in your gene, than asking you to change your habit (stop smoking, drink less, ...) for an actual killer in your lifestyle. Same thing happen for about anything: people are scared of terrorists, but do not driving or even go boozing in high criminality area.

People do not give a shit when they are in charge, so in practice, short of making lifestyle change mandatory by law, you can only really work on the genetic defect. (smoking has 30% to kill you in the next 10 years - does not give a shit. A gene in your DNA give you 10% higher probability to have a heart attack before you are 70 - oh my god, I'm doomed - what can I do doctor)

Personalized medicine = "the cloud"

[neurogeneticist]

The term "personalized medicine" is a buzzword. We've been targeting specific environmental things in specific people for a long time now. It turns out it is hard to get people to get in shape, control their blood pressure, and quit their bad habits. Genetics is as personal as it gets, so that has become the new holy grail. Genetics offers the ability to identify new risk factors and improve understanding of the underlying disease. Many of the identified common and even rare variants in disease don't lead to therapies, but they do tell us about the pathobiology, which may in turn lead to new discoveries and/or therapies. We would love to study gene-environment interactions, but there are major power issues when trying to do studies like this in sporadic, complex disease like heart disease, hypertension, stroke, and the like. We're still trying to develop large enough sample databases and robust analytic techniques that allow us to study the interplay between millions of genetic variants and the often difficult to quantify or report environmental exposures that may act in concert in additive or even multiplicative ways.

Re:Personalized medicine = "the cloud"

[cryptolemur]

It's not a buzzword, nor is it a holy grail.

It's just figuring out (fast) what treatment is the best for a specific individual with a specific condition.

For example, you take a sample of a persons tumor, and in a lab attack it simultanously with over 200 different treatment combinations. Find the most effective combination and report it to the doctor of the patient. Very likely the same cocktail of medication won't work (as efectively) on any other patient.
On a more general level, there are treatments that are completely uneffective when patient has certain genotype, so checking for that before starting the treatment would be smart move, too. Or the other way around, the treatment is effective only with certain genotype.

We don't need to know "why", we only need to couple a patient with treatment that works. We don't need large datasets, we need individual, or personalized, medication.

He's from UPENN, right?

[Anonymous Coward]

First off, this guy probably isn't some quack. UPENN is pretty hardcore about medicine. Second, part of me (the cynical part) wonders if this isn't partially because UPENN is in Philadelphia and Philadelphians (myself being one of them) aren't the healthiest people in the world. Lot's of smokers, an above-average overall occurrence of obesity... Could just be jaded.

Still, I'm inclined to agree. Unless we're talking about most cancers (which genes definitely have a lot to do with) lifestyle does have a major impact on your health and a lot of people like to ignore that.

Orwellian Phrase

[Sponge Bath]

...targeting lifestyle "mistakes"

Doesn't that sound like a conveniently vague catch all for justifying corporate or governmental control over people?

Re:Orwellian Phrase

[BlueStrat]

...targeting lifestyle "mistakes"

Doesn't that sound like a conveniently vague catch all for justifying corporate or governmental control over people?

I'm sorry Citizen, but your statement fails to inspire happy-happy, joy-joy feelings in everyone around you.

Please remain at your present location and await a Protect-Serve patrol that will assist you by transporting you to the nearest Community Adjustment Center to modify your outlook and behavior so as to inspire happy-happy, joy-joy thoughts in yourself and those around you.

Failure to comply may result in a minimum 70 year stay at the nearest cryo-prison facility where you will be subliminally re-educated while in stasis to help you extract maximum self-joy by being an asset to proper, civilized society.

Be Well and Consume.

Because we'd all live forever?

[overshoot]

There are two parts to the "healthcare crisis" in the USA:
1) People who can't afford it and therefore suffer. This includes accidents, communicable diseases, etc. that aren't much dependent on obesity.
2) Huge amounts of resources spent (about half of all healthcare spending) on dragging out the process of dying for people who are, one way or another, going to die soon anyway. Most of them are geriatric patients with incurable progressive conditions: metastatic cancer, congestive heart disease, Alzheimer's, etc.

Better lifestyle practices will give us longer, healthier, and for many of us happier lives. They won't make us invulnerable nor immortal. They won't keep our families from bankrupting themseves trying to add one more week of misery in ICU when our time comes.

Re:Because we'd all live forever?

[Anonymous Coward]

We are all, one way or another, going to die soon anyway. Many of us are born with incurable progressive ageing and may be prone to cancer, heart disease, Alzheimer's, etc.

Some people want to stay alive for longer than you might want them to. One day, you might be fighting to stay alive too (or maybe you don't think so - but maybe you'll change your mind in 50 years' time). It's not as if something better is waiting for them.

The healthcare crisis in the US is the same as all crises: the introduction of profit motive. Whether that's through the privileges of nomenklatura or shares in US health insurance, it always goes wrong in the long run.

Re:Because we'd all live forever?

[InsertCleverUsername]

2) Huge amounts of resources spent (about half of all healthcare spending) on dragging out the process of dying for people who are, one way or another, going to die soon anyway. Most of them are geriatric patients with incurable progressive conditions: metastatic cancer, congestive heart disease, Alzheimer's, etc.

Better lifestyle practices will give us longer, healthier, and for many of us happier lives. They won't make us invulnerable nor immortal. They won't keep our families from bankrupting themseves trying to add one more week of misery in ICU when our time comes.

Precisely. The biggest reason we spend twice as much as other countries on healthcare, yet find ourselves in the company of some third-world countries in outcomes, is that we blow horrible amounts of cash on unnecessary (read CYA for lawsuits) tests and ignorant "futile care" that tortures the dying in order to extend their lives a few months. More here: http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

Re:Because we'd all live forever?

[Qzukk]

we blow horrible amounts of cash on unnecessary (read CYA for lawsuits) tests

And in Texas, we got tort reform and discovered what's really going on is that "we blow horrible amounts of cash on unnecessary (read doctor gets paid per test) tests" http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

Re:Because we'd all live forever?

[Anonymous Coward]

"Better lifestyle practices will give us longer, healthier, and for many of us happier lives. They won't make us invulnerable nor immortal. They won't keep our families from bankrupting themseves trying to add one more week of misery in ICU when our time comes."

Wow, you're absolutely terrible if you think this is a bad thing.

Re:Because we'd all live forever?

[Anonymous Coward]

I agree with you but it is easier said than done. Would you go and justify not spending on people who have a progressive disease to their family members? Even bringing issues like this in front of the people stirs up an ethical drama. One big thing that can be done is tort reform and hence avoiding the frivolous lawsuits that are making the lawyers file class action at the drop of a hat.

Re:Because we'd all live forever?

[sjames]

The really sad thing with the heroic medicine at the end is that it often hastens the end and the majority of the time it destroys the quality of life. I would rather have 8 good months at the end than 12 terrible months.

Re:Because we'd all live forever?

[toadlife]

Great article.

This stood out to me...

Lawrence Gelman was a fifty-seven-year-old anesthesiologist with a Bill Clinton shock of white hair and a weekly local radio show tag-lined "Opinions from an Unrelenting Conservative Spirit." He had helped found the hospital. He barely greeted me, and while the others were trying for a how-can-I-help-you-today attitude, his body language was more let's-get-this-over-with.

So I asked him why McAllen's health-care costs were so high. What he gave me was a disquisition on the theory and history of American health-care financing going back to Lyndon Johnson and the creation of Medicare, the upshot of which was: (1) Government is the problem in health care. "The people in charge of the purse strings don't know what they're doing." (2) If anything, government insurance programs like Medicare don't pay enough. "I, as an anesthesiologist, know that they pay me ten per cent of what a private insurer pays." (3) Government programs are full of waste. "Every person in this room could easily go through the expenditures of Medicare and Medicaid and see all kinds of waste." (4) But not in McAllen. The clinicians here, at least at Doctors Hospital at Renaissance, "are providing necessary, essential health care," Gelman said. "We don't invent patients."

Then why do hospitals in McAllen order so much more surgery and scans and tests than hospitals in El Paso and elsewhere?

In the end, the only explanation he and his colleagues could offer was this: The other doctors and hospitals in McAllen may be overspending, but, to the extent that his hospital provides costlier treatment than other places in the country, it is making people better in ways that data on quality and outcomes do not measure.

"Do we provide better health care than El Paso?" Gelman asked. "I would bet you two to one that we do."

It was a depressing conversationâ"not because I thought the executives were being evasive but because they weren't being evasive. The data on McAllen's costs were clearly new to them. They were defending McAllen reflexively. But they really didn't know the big picture of what was happening.

Re:Because we'd all live forever?

[Anonymous Coward]

The author of the New Yorker article, Atul Gawande, states that the search for answers of the joined issues of healthcare cost-containment and quality-care enhancement will require an empirical approach rather than an ideological one. Good luck with getting that to happen.

The article was both an informative and interesting read. I strongly recommend it to anyone interested in a non-ideological approach to these issues.

What Personalized Medicine Is For

[Samantha Wright]

...Emanuel seems to be missing it by a mile.

This field is for dealing with the little ugly gaps that neither broad pharmacology nor lifestyle adjustment can correct. Take the case of antidepressants, for example: they're extremely finicky (not all work in all people) and have a huge cost in side-effects before the benefits arise. It is an extremely high cost to both the patient's health and the support system to cope with a bad choice of antidepressant. The basis of this fickleness is genetic, and running the right test in advance can prevent bad combinations.

Personalized medicine is not a cure-all, it's a very precise tool in drug design and selection. I'm sure that won't stop lazy physicians and marketers from calling the regular diagnostic process "personalized," though.

Re:What Personalized Medicine Is For

[Anonymous Coward]

You are making very broad assumptions there.

Firstly, antidepressant choice is most influenced currently by overdose risk (TCAs more effective but potentially fatal, SSRI/SNRI much higher margin of safety). The overwhelming complexity of not only the effect of the drug, but the side effects, interactions, and stuff that gets blamed on it for no good reason ("I remember last time I had paracetamol I had a headache. Paracetamol therefore gives me headaches. I'm allergic to it.") means that genetic profiling is unlikely to make ay significant inroads into this.

Secondly, the likelihood of success with a genetic based approach is pretty low. We might be able to say things like "black people tend to get more benefit from calcium channel blockers for high blood pressure compared to an ACEI" but on an individual basis that's less convincing.

Thirdly, the evidence base from the clinical trials we do base what we know on is AWFUL. Shoddy, self-interested poorly performed research with drug company claws all over it. There are exceptions, but the profession is currently struggling with how to 2.0 the peer review process so that it is as valid as its goals are.

Lastly, the problem is not 'lazy physicians'. We don't order a test that doesn't exist because we can't be bothered, any more than you couldn't be arsed getting fresh moon rock to hold your door open this morning due to your inherent idleness. If a way to select a better drug based on the patient does exist (there are a few ways this can sort of be done, but they are all subpopulation rather than individual based) then it will be used - it just has to be cost effective, accurate, outcome-changing, and valid.

What he is saying is that if we divert our time, energy and money into something that works, could significantly reduce the burden of disease, and has a lot of 'bang for buck' in terms of healthcare dollar, then that would make more sense than investing squillions into something that probably won't work, and even if it does, it will affect a small number of people at great expense.

The drug companies fired all their pharmacists and chemists a few years back because they thought the future was molecularly engineered drugs based on 3D models of receptors. Dismal failure. They had to rehire. Just because we can think of a theoretical treatment, doesn't mean it will work. This is similar. Do the research, see what it shows. If it works - great. If not - move on to another idea or refine it.

Re:What Personalized Medicine Is For

[Samantha Wright]

I apologise for being overly broad, and I most certainly did not mean to attack physicians as a group; I was merely commenting on one way in which a very vague-sounding term might be abused. I'm currently working with a lab conducting just such a study on two very specific antidepressants, but I'm under an NDA.

Re:What Personalized Medicine Is For

[UpnAtom]

Any evidence the "fickleness" is genetic?

Or that the blind hasn't been broken in any anti-depressant trials for that matter...

Re:What Personalized Medicine Is For

[Samantha Wright]

Not every substance has this property, but yes: the field is called pharmacogenetics/genomics.

This article ignores one of the larger benefits

[Anonymous Coward]

We're all focusing on the claim that personalized medicine is being used to exclusion of usual prevention. I don't think anyone is claiming that it will replace prevention. The argument here is ignoring other benefits.

One of the very real uses of personalized medicine/genomic diagnostics is treatment sensitivities. CYP450 is a perfect example of a variant that determines how you will react to medication. There are subsets of cancer that will respond to certain treatments and not others, and this is a way that we can elucidate these sorts of things.

Disclosure: I work on this stuff. It is a fishing expedition, but the benefits are very much worth it.

Not true

[rsilvergun]

the 'healthcare crisis' is because the nature of healthcare changed and the delivery mechanism did not. In the 1970s, healthcare was very limited. A doctor could set a bone, stitch you up, and blast you with radiation hoping for the best. In 40 years we've moved to things like personalized medicine (where for the price of $10,000 a month an aids patient can thrive, plus a raft of preventative medicines and maintenance medicines. Do you see the shift? We've gone from caring for a few major disasters and making you comfy when you die to maintaining the human body like you would any other machine.

An insurance model for delivering healthcare works for disasters and a one time end of life expense. It breaks when you're using healthcare for maintenance. The thing anyone without socialized medicine is, unless you're so rich you can drop $10k/mo, you don't really have healthcare. Because as soon as you need it, I'm mean you're really going to use it and use it regularly, your insurance provider is going to take it away. That's why America socialized medicine... for the elderly. But even they're going to lose it soon. Just you wait. You think it's there, but it's not. And by the time you realize it, it'll be too late. Poverty will crush you and you won't matter any more. You'll just fall by the way side.

Re:Not true

[Anonymous Coward]

Warning: Parent is a link farmer.

Re:Not true

[rsilvergun]

What's a link farmer? I'm the parent and I don't know what that is...

Re:Not true

[rsilvergun]

Oh, if you mean that link to Magic Johnson, it's the first hit in google for 'Magic Johnson thrives'.

He's a pragmatic dinosaur?

[Idou]

There are examples of people who have been very absusive to their bodies and yet lived long, healthy lives (Ossy, anyone?). There are other people who seem to be cautious enough, yet deal with various health issues. Having better information up front about one's own genetic risks allows for better decisions based on reality, not "professional" opinions founded on years of "experience" of observing the outputs of a very complicated black box by your doctor.

Bottom line, DNA is the source code of how our bodies work. Some may think it is pretty useless at this point, but we will only truly understand its value once we understand it. Most of science works like this . . .

Re:He's a pragmatic dinosaur?

[RobertLTux]

the big problem with DNA = Source code for person = Absolute Gospel on That Person is one of those simple/complex things

Even if you have source code delivered as a set of QRcodes engraved on Gold tablets by Angels you still need to worry about

1 the developers "stack"
2 the System it is run on
3 what other programs are running on The System
4 versions of various system libs installed
5 Power and other Environmental concerns

Hitlers Own Superman would still drop dead at 13 if he was not fed correctly and given a decent home (and would croak at 17 given a stress filled job)

But i would bet that insurance companies will drop/ not carry a person because their gen profile shows they are 0.0005% more likely to get %condition% if they can get ahold of the info.

all jobs needs paid sick days as some places

[Joe_Dragon]

all jobs needs paid sick days as some places make sick people come in to work and even with paid sick days to many boss have the suck it up idea and that just get's the full office sick. In foodservice this get's others sick as well.

One major problem with medicine. . .

[Anonymous Coward]

Is that most people don't want to live healthy lifestyles. And, you know, I could care less. If someone wants to kill themselves slowly by smoking, drinking, being sedentary, and eating garbage, so be it. In a free society, with free association and free expression, one SHOULD be able to live badly or even kill themselves, provided they aren't hurting anyone else. I might not agree with it, but it's not my life, and from a moral standpoint, I have no right to impose my concept of lifestyle on them.

Wrong question but right answer

[RandCraw]

The goal of personalized medicine is to identify which genomic pattern in a population will respond to a given drug, or identify which drug will work for a given person's genome. It has nothing to do with improving public health policy and only tangentially with reducing health care costs. It has a lot to do with reducing time-to-treatment and making drugs more efficacious.

Emanuel is right that it's nuts to waste money on gene-based treatments which target only the symptoms of disease, when fixing the disease itself necessarily requires a change in lifestyle, which is something that technology cannot and will not fix. Once we accept this, the next step is simply, "How"?

All western countries are healthier than the US. Let's start by looking at what they're doing and then reward americans for doing more of that.

Re:Wrong question but right answer

[elucido]

The goal of personalized medicine is to identify which genomic pattern in a population will respond to a given drug, or identify which drug will work for a given person's genome. It has nothing to do with improving public health policy and only tangentially with reducing health care costs. It has a lot to do with reducing time-to-treatment and making drugs more efficacious.

Emanuel is right that it's nuts to waste money on gene-based treatments which target only the symptoms of disease, when fixing the disease itself necessarily requires a change in lifestyle, which is something that technology cannot and will not fix. Once we accept this, the next step is simply, "How"?

All western countries are healthier than the US. Let's start by looking at what they're doing and then reward americans for doing more of that.

Start with clean air, food and water.

Re:Wrong question but right answer

[Anonymous Coward]

For making life style changes, I think a higher quality of life is a good enough reason to make changes, but it isn't easy at first. Facing cancer definitely lights a fire under your ass.

I wish there were good incentives for other people. It would be great to have some cheap way to evaluate health so we could reward good health due to good lifestyle choices. As far as I know, the only incentive for US citizens is you get life and health insurance discounts for not smoking if you buy the insurance yourself. You would have thought the "free market solves everything" types would have been all over health scoring and rewarding, but I don't think I've seen any suggestions outside of economics blogs.

I doubt it

[overshoot]

One day, you might be fighting to stay alive too (or maybe you don't think so - but maybe you'll change your mind in 50 years' time).

If I'm still alive at 110, I doubt very much that I'll be all that stressed out about checking out. Plenty of family members have gone peacefully when they got tired of living -- including my maternal (step-)grandmother who basically just withdrew until she shut down and my paternal (step-)grandmother who lived to 97 and got tired of burying children and grandchildren. I think my mother is headed that way soon.

So be it. Give me a good view out over the Rio Grande and some (great-)grandchildren in the house. It's been a blast so far and the rest is gravy.

Go get Ayds and live

[tepples]

You can get people to take a pill a day more easily than giving up the cheeseburgers.

Then why not bring back Ayds? Unlike AIDS, Ayds was a safe and effective appetite suppressant candy that one would eat before a meal to decrease one's desire to "has cheezburger".

Re:Go get Ayds and live

[geminidomino]

If it worked that well, it's hard to believe they deep-sixed the product rather than just change to a new name (Gee, going from "Ayds" to "Diet Ayds" didn't break the memetic connection to AIDS? SHOCKER!).

Deadlines

[InsertCleverUsername]

Dr. Emanuel's thinking seems right on this; there's evidence that "genetics only account for approximately 20 to 30 percent of an individual's chance of surviving to age 85." (see Scientific American) Maybe rather than provide cures, personalized medicine could be used to give people a more accurate estimate of how long they're going to live, based off various lifestyle decisions. Nothing motivates like a deadline.

False Dichotomy

[DaveV1.0]

Is Emanuel a dinosaur or a pragmatist?

Of course, the submitter left off the fact that he might be neither a dinosaur nor a pragmatist. Rather, he could be quite correct in his assessment.

Hurting others in their family

[tepples]

In a free society, with free association and free expression, one SHOULD be able to live badly or even kill themselves, provided they aren't hurting anyone else.

People with medical problems might be hurting others in their family. And they might be hurting the general public when they turn to crime to support a way to get healthy again, as dramatized in the 2002 film John Q.

High Fructose Corn Syrup

[Anonymous Coward]

High Fructose Corn Syrup has the same number of calories per gram as any other carbohydrate (including so-called "zero calorie" sweeteners). What differs is the level of sweetness per gram. All sugar interferes with your body's "I'm full" hormone.

HFCS provides a smoothness to drinks which is hard to accomplish with cane or beet sugar.

Re:High Fructose Corn Syrup

[tomhudson]

Instead of making the same misleading argument the HFCS lobby always makes, why don't you address the point that I wrote - that it's the action of HFCS on the body's hormones that makes the difference, not the calories.

Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women.

Previous studies indicate that leptin secretion is regulated by insulin-mediated glucose metabolism. Because fructose, unlike glucose, does not stimulate insulin secretion, we hypothesized that meals high in fructose would result in lower leptin concentrations than meals containing the same amount of glucose. Blood samples were collected every 30-60 min for 24 h from 12 normal-weight women on 2 randomized days during which the subjects consumed three meals containing 55, 30, and 15% of total kilocalories as carbohydrate, fat, and protein, respectively, with 30% of kilocalories as either a fructose-sweetened [high fructose (HFr)] or glucose-sweetened [high glucose (HGl)] beverage. Meals were isocaloric in the two treatments. Postprandial glycemic excursions were reduced by 66 +/- 12%, and insulin responses were 65 +/- 5% lower (both P Because insulin and leptin, and possibly ghrelin, function as key signals to the central nervous system in the long-term regulation of energy balance, decreases of circulating insulin and leptin and increased ghrelin concentrations, as demonstrated in this study, could lead to increased caloric intake and ultimately contribute to weight gain and obesity during chronic consumption of diets high in fructose.

HFCS makes you feel hungry, even when you have enough calories, because of the way it acts ont eh bodys hormones. Cane sugar does not. Simple as that.

Re:High Fructose Corn Syrup

[TheCarp]

Not true.... Cane sugar is sucrose. Sucrose is rapidly decomposed into fructose and glucose in the body. So sugar is equivalent to HFCS in every way.

Re:High Fructose Corn Syrup

[tomhudson]

No, it's not. The process of breaking it down changes the body's hormone levels. Read the results of the study (links posted elsewhere in this particular thread) and educate yourself instead of pushing lies.

Bad lifestyle is a choice, bad genes isn't

[Kjella]

Honestly, if you do the things you do you've decided that the perks outweigh the disadvantages. If you decide that gorging at McDonald's is better than eating a salad, that's a choice. If you decide a night out on the down getting seriously drunk or high is worth it, it's a choice. As long as I've paid plenty money in beer taxes and you can probably chop a year or two off my pensions relative to the healthy guys to cover any alcohol related injury or illness, what business is it to anyone else if I choose to poison myself? Because, yeah that's the toxic part of intoxication and in mild forms it's very comfortable. And I still expect good medical treatment because I have paid for that extra risk, least that's the way I feel it works here in Norway with high alcohol tax and universal healthcare. Same with smokers, they surely pay more than the cost as there's a real witch hunt out for them. They don't tax drugs because they're illegal and McDonald's because they haven't found a good way, but I'm sure they want to. Oh yes, and I'm aware that's not entirely true that it's my own business since you have things like a few people getting aggressive and violent when drunk, but the health effects are my business.

People with bad genes though, they can't help it. They never had that choice, they were born with the choice already made for them. Maybe a few things you can help with - like more intense cancer checks if you know you're predisposed for cancer - but I'd say the far more interesting part would be looking for cures, before you even get so far as the disease. Oh you're predisposed to cancer, here's a shot of retrovirus that will change those genes before it even gets so far. Or better yet, if we find people with immunities or other good qualities we can use that almost like a vaccine. Natural selection has practically no effect when you're past the age people get kids, if we want to live longer and healthier we'll probably have to manipulate our bodies to do that ourselves. And don't give me anything about my genes being who I am, if you offer me a gene-altering drug so that'll I never get Alzheimer's and end my life like a mindless zombie I'd take it. Feel free to refuse, I hear there's people that won't even take blood transplants and I respect that, just don't expect me to agree with them.

Re:Bad lifestyle is a choice, bad genes isn't

[misexistentialist]

A lot of people choose to spread their obviously bad genes, and breed past their gametes' expiration date, so there is still choice in there. Dysgenics should not be promoted by giving parents of defectives extra money and attention.

Personalized medicin is NOT just genetics

[gurps_npc]

Any person with a single serious disease has to get personalized medicine.

I am constantly bombarded by idiots telling me things like "eat less carbs", but my personal medical issues makes eating more protien worse for my body than eating carbs.

ALL medicine should be personalized - not just for your genes, but for your particular conditions.

Not only that

[Sycraft-fu]

But maybe it can lead to better knowledge of what lifestyle factors matter to an individual. This idea that there is the One True Lifestyle is just as silly as the idea that one drug works for all. Different people have different things they need and so on. This would be why there are those people who can drink and smoke and not exercise all their life, and yet live to a ripe old age (my grandpa is one of those). For most people, those choices are harmful, for some that matter little to not at all.

Or things like "Don't eat salt, it'll raise your blood pressure," no actually, that's not at all the case. Some people will not have high blood pressure, it just isn't a problem for them. Salt intake is totally irrelevant to that for them. Others will have high blood pressure and reducing sodium intake won't do anything for it, it will require other things. Others still will have their blood pressure affected by sodium intake, and thus will need to limit it to keep their blood pressure under control.

So it would be great if we could figure this out, and tailor medical advice to the individual. Figure out what is and isn't important to that person.

Ban ingredients like HFCS

[elucido]

If obesity is such a concern the political solution is the best solution to cut healthcare costs.

Start by banning HFCS on the federal level and all chemicals like it. Just like asbestos had to be banned, HFCS has to be banned. Pollutants have to be regulated as these environmental factors affect the metabolism as well. Pollution in the plastic containers for example.

After the unhealthy ingredients such as HFCS and transfats are banned then we can logically tackle the obesity problem. Until that point we cannot take any initiative to combat obsesity seriously.

Leverage the internet and patient self interest.

[elucido]

On one level the patient has to take more responsibility for their health but on the other level the patient should be as well informed as their doctor. There used to be a time where you had to go to medical school to learn certain things. On some level that is still the case. Get rid of the paywalls for medical journals so that patients can keep up with the latest research.

Allow patients to be diagnosed through the internet through remote terminals if necessary. The technology will eventually exist to detect metabolic syndrome using light sensors. The technology will eventually exist to detect blood sugar levels using the same means or through breath. Blood pressure could be remotely determined as well. Remote monitoring will be the major advance.

Don't get me wrong medicine will always be expensive and it probably should be, but it doesn't have to be as expensive as it is. First there aren't nearly enough doctors. Second the cost of medicine is way more expensive than it has to be. Third there isn't enough focus on prevention or preventative care.

Personalized medicine might tell a doctor what sort of preventative care program to put a patient on but it wont necessarily prevent anything if the environment is continuously polluted to the point where the patient gets sick regardless of lifestyle. The asthma epidemic is environmental not lifestyle. Children are developing obesity so it's not lifestyle anymore. What are we going to do? Wait until children are dying of heart attacks and cancer before we figure it out?

Even if they follow it, it wont matter.

[elucido]

Their air will still be toxic. Their water will still be polluted. Their food will still be processed with chemicals.

What do you expect? No amount of lifestyle change can protect you from every possible form of pollution in the environment.

Different things hurt different people

[elucido]

For some people smoking is more dangerous than a high calorie slice of pizza and coke each day. For another person it's drinking. For another person it's something else.

However there are industrial chemicals that hurt everybody regardless of genes. Those have to be removed.

Then depending on what genes a person has and what harms that persons health a personal lifestyle program can be designed. Some people will never get obese and can't put on fat no matter what or how much they seem to eat. Another person puts on fat easily. This is entirely genetic.

But the person who gets fat easily shouldn't eat the same way or act the same as the person who never gets fat. Just like the person who gets addicted to drugs shouldn't smoke while the person who never gets addicted can avoid a drug problem. Lifestyle changes can help but lifestyle changes don't solve every problem and aren't really the responsibility of the doctor any more than the doctor can solve asthma by making the air less polluted.

You're being silly

[rsilvergun]

Patients can't do that. Healthcare diagnosis is too complex. There have been several stories on this and it's the other reason why private insurance based healthcare doesn't work. I won't try to explain it myself, just read this article. Long story short, buying 'healthcare' != 'pizza'.

Even if true, some won't believe it:

[Hartree]

"Their air will still be toxic"

In some places. Certainly better than Gary Indiana was in the early 70s. I can vouch personally for that.

"Their water will still be polluted"

In some places. But I'll take my chances with small amounts of runoff related chemicals as opposed to the old style pollutants like sewage, cholera, shigella, etc.

"Their food will still be processed with chemicals"

I'm still waiting to see this food with no chemicals. Every bit that I've seen has chemicals like sodium chloride, dihydrogen monoxide, and an array of chemicals so complex and unknown that we can't even begin to synthesize them in a laboratory.

You would have though that such a marvel would be known to the researchers at a major ag/food science/biochem research university where I work.

Maybe they're all just paid off by the $conspiracy. ;)

Re:Even if true, some won't believe it:

[elucido]

"Their air will still be toxic"

In some places. Certainly better than Gary Indiana was in the early 70s. I can vouch personally for that.

"Their water will still be polluted"

In some places. But I'll take my chances with small amounts of runoff related chemicals as opposed to the old style pollutants like sewage, cholera, shigella, etc.

"Their food will still be processed with chemicals"

I'm still waiting to see this food with no chemicals. Every bit that I've seen has chemicals like sodium chloride, dihydrogen monoxide, and an array of chemicals so complex and unknown that we can't even begin to synthesize them in a laboratory.

You would have though that such a marvel would be known to the researchers at a major ag/food science/biochem research university where I work.

Maybe they're all just paid off by the $conspiracy. ;)

So because it was toxic in the past it's okay to make the future even more toxic? At some point it's going to cause problems thus you have more sick people with preventable illnesses.

This is just nonsense

[Kohath]

This is just nonsense. You guys talk about HFCS and chemicals and hormones the way that tribal peoples talk about evil spirits. If you just say the right words and eat the "clean" foods, you'll be protected from the evil spirits and the sorcerers and the witches lurking out in the darkness.

Fructose is just fruit sugar. It's abundant in apples and pears and other fruits. Also in honey. It's not magic. It's not evil. It's sugar. Too much is bad for you, just like any other sugar or starch.

Please try to either be rational or be quiet. Thanks.

Re:This is just nonsense

[tomhudson]

The process of metabolizing fructose has a different effect on the bodys hormones than the same number of calories of glucose. Educate yourself on the difference.

In other words, take your own advice - either be rational or STFU.

Re:This is just nonsense

[TheCarp]

There is a big difference between being rational and being informed. Clearly you don't understand that, as you told me to get educated and stop pushing lies, elsewhere, leading me to think that you feel there is some sort of choice to be ignorant at work here.

You have better information...fine, good, thanks for the link. Is this the one you were pointing me at because I will go read it now, but to accuse people of being irrational for not being as informed as you like to claim to be is hardly helpful.

Re:This is just nonsense

[Kohath]

The process of metabolizing fructose has a different effect on the bodys hormones than the same number of calories of glucose.

So what? HFCS fructose is the same fructose as in an apple. It's not a magic, evil version of fructose.

Re:This is just nonsense

[tomhudson]

It would have taken all of what, 15 seconds to search for "HFCS hormones" after I made it quite clear in the original post that the problem was the effect of HFCS on hormones linked to appetite. Did people try this? Nooooo ... they just blithely posted some misinformation rather than doing any fact-checking. THAT is irrational behavior.

This "too lazy to look it up because I'd rather just shoot my damn fool mouth off and add to the echo chamber" makes them part of the problem, not the solution, and if you look through the thread (and many other threads), it's this "intellectually lazy don't wanna know unless you spoon-feed it to me" attitude that is a BIG part of the problem with society in general. Most people essentially stop learning by their early 20s.

And it's completely on-topic, because the people who are guzzling HFCS and claiming it doesn't make a difference because "it's all sugar" are just too damn lazy to even TRY to back up their assumptions. It's not "what you know," it's "what you know that ain't so" - and this "too lazy to challenge basic assumptions" contributes in large part to the current epidemic of obesity.

Re:This is just nonsense

[tomhudson]

You don't get HFCS from apples. What part of High Fructose Corn Syrup don't you "get"? Do you say "A corn a day keeps the doctor away?" "As American as corn pie?" "Corn dumplings". "Bobbing for corn?" "Corn Computers?" "Corn Streussel Cheesecake Bars?" "Apple on the Cob?"

Oh, right, you'd rather accuse ME of being irrational for having an opinion based on scientific research than to challenge your fact-free assumptions and your lack of reading skills. How dare I!

Instead of accusing me of being irrational and that I should remain silent, you could have googled for "hfcs hormones" - lots of relevant results (and I've linked to one study elsewhere in the thread).

The fast-food/junk-food producers aren't using fructose from apples, but from corn. Restricting fructose from apples would have no impact whatsoever on the problem.

Re:This is just nonsense

[Kohath]

The fast-food/junk-food producers aren't using fructose from apples, but from corn.

The substance is exactly the same. Corn fructose is apple fructose. They are exactly the same.

Maybe I should repeat it again: they are exactly the same.

You don't get HFCS from apples. What part of High Fructose Corn Syrup don't you "get"? Do you say "A corn a day keeps the doctor away?" "As American as corn pie?" "Corn dumplings". "Bobbing for corn?" "Corn Computers?" "Corn Streussel Cheesecake Bars?" "Apple on the Cob?"

You're making my point. Bigotry against corn (or whatever your weird, irrational hangup is) doesn't change the chemical makeup of fructose.

Corn fructose isn't possessed by evil spirits or cursed by voodoo sorcerers either.

Re:This is just nonsense

[tomhudson]

And you are missing BOTH points, so I'll spell it out step by step. TRY to follow along this time, mkay?

1. WHEREAS fructose changes hormone levels differently than other sugars.
2. WHEREAS in the case of fructose, those hormone levels keep you from feeling full.
3. THEREFORE, eating as much fructose from apples will cause as much overeating as eating fructose from corn.
4. WHEREAS corn is hugely subsidized.
5. THEREFORE it is because corn is so subsidized that it is used instead of other sugar sources.
6. THEREFORE ending the corn subsidy would get producers to use other sugar sources.
7. THEREFORE the discussion is targeted on fructose in HFCS and not fructose in apples, because apple-sourced fructose isn't currently being used as a cheap sweetener.

Re:This is just nonsense

[Kohath]

But in your original post you didn't say "stop subsidies" you said "ban HFCS". There's no call for a ban. HFCS is no more harmful than honey or apples. Saying otherwise is irrational. Banning of a perfectly safe product is unjust.

We should obviously stop the subsidies. I'm in favor of stopping all subsidies for everything. Corn subsidies can go first.

And obese people should stop eating as much HFCS. And every other sugary or starchy food.

Re:This is just nonsense

[tomhudson]

HFCS should be banned as a sweetener. Why keep allowing an additive which negatively impacts the biochemistry?

And it's not just obese people who are affected. Even those who are either just over-weight, or normal weight but get too many of their calories from sugars because their appetite is thrown out of whack because of the effects of HFCS on their hormone levels, will benefit.

Just because something comes from a natural source doesn't make it good for you. I can get cyanide from apple seeds and peach pits.

Re:This is just nonsense

[Kohath]

How many years should people be imprisoned because they don't agree with your view of what's The Right Sweetener? Do you want your food police to carry guns and break down doors? Should they have HFCS-sniffing dogs?

We'll also have to ban honey and every other product that can sweeten similar to HFCS -- bad for the biochemistry. And someone once told me alcohol could negatively impact biochemistry. That will have to be banned too. And 1000 other things.

Re:This is just nonsense

[tomhudson]

Why not just admit you were stupidly off-base with your original remark? That you completely missed the point, and that your comparison to apples was equally silly?

We ban stuff all the time. Things like mixing ethylene glycol in wine to "make it go further" because sticking antifreeze in makes people go blind. Do you have a problem with that? Do you think it's stupid?

HFCS is not a naturally-occuring product. You don't get HFCS out of a hive the same way you do honey.

And the last time I looked, we *do* regulate the sale and consumption of alcohol.

All you're proving with your dumb-ass comments is that you completely missed the original point, and now you obese (HFCS-inflated???) ego won't let you admit it. You accused me of nonsense, but it's YOU who have been spinning the nonsense. Grow up. Really.

Re:This is just nonsense

[Kohath]

No, my original comment was correct. People like you think of food additives like evil spirits and seek to banish them.

You also want to create food police to enforce your food preferences on people. You want to fine or jail or otherwise punish people to force them to accept your choices instead of freely making their own.

And you're willing to ignore or deny the simplest facts to further your goals.

Re:This is just nonsense

[tomhudson]

No - your original comment completely missed the point - fructuose is metabolized in such a way as to decrease the ability of the body to sense that is full and stop eating, and as such such, makes people hungrier. People who drank a bottle of soda pop before meals ate more than people who didn't for that very reason.

You are the one who ignores both the biological studies (link provided elsewhere) and the epidemiological studies because YOU want to ignore or deny the facts to further your ignorant attitudes.

Science says you're wrong. Get over it, and over yourself.

Re:This is just nonsense

[Kohath]

No "biological studies" say corn fructose is different than honey fructose. You keep missing the point.

Because facts don't matter to you, forcing people to live their lives according to your preferences is all that matters.

Re:This is just nonsense

[tomhudson]

No, you missed the point - ALL fructose - no matter what the source - affects the metabolism differently than sugar from cane or beets.

Two options - you're either a shill or incredibly stupid, even by /. standards.

Personalised Medicine: disaster waiting to happen

[GrandTeddyBearOfDoom]

To be able to personally tailor medicine to an individual, you need an effective diagnostic mechanism, and an effective way to decide, based on the diagnosis and the patient, what course of treatment will work. Trying to do this on the basis of a patient's genetics is unlikely to be effective in the near future, if at all.

Te begin with, studies of the kind we see today tend to give results like 'gene X affects incidence of disease Y by n%'. To rely on this for a diagnosis and treatment amounts to a guessing game, and the number of such n% guesses compounded together will cause accuracy of the diagnosis to be little better than random chance, yet appear to have the certain blessing of the medical establishment. Establishing the effect of a gene is, in any case, far less certain than seems to be made out, because there is little understanding of how an altered gene causes a problem even if a correlation is detected.

I fear personalised medicine is the road to mass Russian Roulette medicine, and I hope the 'brave new and shiny' factor doesn't cause it to be overly relied upon.

And you're doing -- what? -- about that?

[overshoot]

I do trust that you have legally-binding advanced directives on file, with a wallet card and all pointing folk to them. (One of the few things Arizona has done right lately is set up a central AD registry.)

You have, right?

Bad things

[overshoot]

Wow, you're absolutely terrible if you think this is a bad thing.

I obviously wasn't clear. FWIW, I have legally-enforcable advance directives (not to mention some kids and a mistress who have heard me rant about it for years) to make sure that nobody can spend what I've saved for my grandchildren on useless ICU charges.

Re:And you're doing -- what? -- about that?

[sjames]

My wishes are well known and documented. Of course, in the scenario I was speaking of, I will be able to convey those wishes personally.

The problem, summarized

[Fned]

"profit motive".

Markets are not good tools for optimizing emergency services.

Um.. What?

[Ragun]

So when someone gets cancer are you going to tell them to workout more, or do you want to test their gene expression profile and match it against a drug that targets a suggested pathway?

Maslow's hierarchy of needs

[tlambert]

Maslow's hierarchy of needs: http://en.wikipedia.org/wiki/Maslow's_hierarchy_of_needs

Healthcare is a Safety need. It's lower on the list than Physiological needs.

How about we tackle the more immediately problems of food, clothing, and shelter for everyone, and then we can move on to the rest of the hierarchy after those are solved?

-- Terry

Re:Maslow's hierarchy of needs

[Tsingi]

It's pretty sad that food clothing and shelter are even an issue in developed countries.

How to escape the Pleasure Trap

[Paul Fernhout]

http://www.drfuhrman.com/library/article16.aspx
"Tragically, most people are totally unaware that they are only a few weeks of discipline away from being able to comfortably maintain healthful dietary habits -- and to keep away from the products that can result in the destruction of their health. Instead, most people think that if they were to eat more healthfully, they would be condemned to a life of greatly reduced gustatory pleasure -- thinking that the process of Phase IV will last forever. In our new book, The Pleasure Trap, we explain this extraordinarily deceptive and problematic situation -- and how to master this hidden force that undermines health and happiness."

Allergy to GM food

[tepples]

The main difference is their attempts at making them sterile so that they are the only source for said variant. That's where problems exist.

That and the fact that unlike traditional GM, recombinant GM changes food faster than people's digestive and immune systems end up adapting. For example, a gene from a Brazil nut tree got spliced into soybeans used in cattle feed. Beef from cows who ate that feed ended up triggering reactions in people with a Brazil nut allergy.